Can Lumbar Mulligan Mobilization Improve Gait, Balance, and Trunk Position Sense After Stroke?

Condition(s) studied

Investigational drug(s) / intervention(s)

Experimental Group (Mulligan Mobilization + Conventional Therapy): Mulligan Sustained Natural Apophyseal Glides (SNAGs) applied to the lumbar spine, combined with conventional rehabilitation exercises (neuromuscular training, stretching, strengthening, and balance exercises).

(Conventional Therapy Only): Neuromuscular training, stretching, strengthening, balance exercises, and gait training performed without Mulligan mobilization.

Study summary

Stroke is a pathology caused by disturbances in the brain's arterial circulation, leading to high morbidity rates. Individuals who experience a stroke often face neurological impairments such as motor, sensory, and cognitive dysfunctions, which negatively impact muscle strength, postural control, sensation, and gait, reducing their independence in daily activities. Balance deficits in stroke patients increase the risk of falls and contribute to a fear of falling. Improving balance control is a key goal in rehabilitation. The importance of the trunk in balance control and rehabilitation is well-established, as it plays a central role in maintaining stability. In individuals with restricted lumbar mobility, weakened trunk muscles and altered muscle activation can lead to a reduction in proprioception, hip strategy, and spinal stabilization, further impairing balance. Combining conventional exercise approaches with other rehabilitation techniques has been shown to yield more effective outcomes. This study aims to investigate the effects of Mulligan-based lumbar spine mobilization on balance, trunk position sense, and gait in individuals with stroke.

Eligibility

Primary outcome measure(s)

• Static Balance Assessment (Mini-BESTest) — Baseline and After 4 Weeks
  The Mini Balance Evaluation Systems Test (Mini-BESTest) assesses balance control, including anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. It consists of 14 items scored from 0 to 28, with higher scores indicating better balance.
• Static Balance Assessment (ALDA Balance Device) — Baseline and After 4 Weeks
  The ALDA Balance Device uses a motion sensor placed at the L3-5 vertebrae to assess postural sway. It records movement data via a wireless system to analyze balance responses.
• Dynamic Balance Assessment (Trunk Impairment Scale - TIS) — Baseline and After 4 Weeks
  The TIS assesses trunk control in stroke patients through three subcomponents: static sitting balance, dynamic sitting balance, and coordination. The scale consists of 17 items, with a total score ranging from 0 to 23, where higher scores indicate better trunk control.
• Dynamic Balance Assessment (Functional Reach Test - FRT) — Baseline and After 4 Weeks
  The Functional Reach Test evaluates balance stability by measuring the maximum distance a participant can reach forward while maintaining a fixed base of support. Three trials are conducted, and the average distance is recorded. A reach distance of 15 cm or less indicates a high fall risk.
• Gait Performance (Dynamic Gait Index (DGI)) — Baseline and After 4 Weeks
  Assesses functional mobility and dynamic walking ability under different conditions (e.g., changing speeds, stepping over obstacles).
• Gait Performance (10-Meter Walk Test) — Baseline and After 4 Weeks
  Measures gait speed by recording the time taken to walk 10 meters.
• Trunk Position Sense (Proprioception) inclinometers test — Baseline and After 4 Weeks
  Inclinometers are among the most commonly used methods for measuring trunk position sense and proprioception. the participant will be guided into a 30° lumbar flexion position three times while standing and will be asked to memorize this position. Then, the participant will be instructed to close their eyes and attempt to replicate the same position. After returning to an upright stance, they will be asked to find the 30° flexion position again. This process will be repeated three times, and the results will be recorded.

Trial sites (1)

More Gulhane School of Medicine trials in Turkey