Type of Article:  Original Research

Volume 6; Issue 4 (August 2018)

Page No.: 2813-2822

DOI: https://dx.doi.org/10.16965/ijpr.2018.156


Kanika D. Muniyar 1, Shrikant B. Darade 2.

1 Nanded Physiotherapy College & Research Center, Nanded, Maharashtra, India.

2 Assistant Professor, Nanded Physiotherapy College & Research Center, Nanded, Maharashtra, India.

Author Address: Kanika Muniyar, Nanded Physiotherapy College & Research Center, Nanded, Maharashtra – 431606. E-Mail: kanumuniyar@gmail.com


Background: Post-stroke is a major heath disorder which is the commonest cause of disability worldwide. There is multi directional impairment of group of muscles. Balance & postural control is an important functional outcome & also an early predictor for functional activities of daily living after stroke. Early treatment focusing on the aspects of disabilities is needed. Swiss ball training & conventional physiotherapeutic interventions are superior methods to improve the agility of weaken core- muscles by increasing their demand & trunk balance on individuals.

Methodology: A total of 40 subject were selected from the age group between 45 and 65 and the study group was formed by using convenient sampling technique. Pre –evaluation was done on the basis of Berg Balance Scale(BBS) & Time up and go test (TUG). The Intervention used was Swiss ball training program with conventional physiotherapeutic techniques for a time –period of 45min to 1 hour. Treatment session was done 2-3 times per day & 3-5 times per week. Then a post-evaluation was done to conclude the results from data obtained.

Results: By using Graph Pad version3.0, the considered p value for BBS & TUG was > 0.05 where they obtained value was p < 0.0001, which is statistically significant.

Conclusion: Effect of Swiss ball training & conventional physiotherapy was effective to improve balance & mobility and also showed a better quality of life in post stroke patients.

Key words: Balance, mobility, stroke, BBS, TUG, Swiss ball, conventional physiotherapy.


  1. Dally S, and Ruff RL, Electrically induced recovery of gait components for older patients with chronic stroke, Am J Phys Med Rehabil. 2000;79:349- 60.
  2. Thompson JE, The evolution of surgery for the treatment and prevention of stroke. The Willis Lecture, Stroke1996;27(8):1427- 34.
  3. Kopito, and Jeff, A Stroke in Time. 6(9), 2001, MERGINET.Com.
  4. Stroke recommendations on stoke prevention, diagnosis and therapy. Report of WHO task force on stroke and other cerebrovascular disorders, stroke 1989;20:1407-1431.
  5. Darcy A.umphred, SusanP.Ryerson.Chapter 27 Hemiplegia.neurologicalRehabilita -tion 5th edition.Elesvier 2007;858,863,877.
  6. Rajrupinder Kaur Rai, Lalit Arora, SmatiSambyal, Reena Arora. Efficacy of Trunk Rehabilitation and Balance Training On Trunk Control, Balance and Gait in Post Stroke Hemiplegic Patients: A Randomized Controlled Trial. IOSR-JNHS.May -Jun 2014;3:27-31.
  7. Yuk LanTsang. “Sit and Reach Test can predict mobility of patients recovering from Acute Stroke”ArchPhysMedRehabil 2004;85:94-8.
  8. O‟sullivan SB & Schimtz, Physical rehabilitation assessment and treatment. 2003;5thed,pp.705-709.
  9. World Heart Federation.http://www.world-heart-federation.org/cardiovascular-health/stroke
  10. Stroke –Wikepedia ,free encyclopedia
  11. Karatas M, Cetin N, Bayramoglu M, Dilek A. Trunk muscle strength in relation to balance andfunctional disability in unihemispheric strokepatients. Am J Phys Med Rehabil. 2004 Feb;83(2):81-7.
  12. jijimolg, fayazrk.Correlation of trunk impairment with balance in patients with chronic stroke.NeuroRehabilitation. 2013;32(2):323-5.
  13. Bohannon RW, Cassidy D, Walsh S. Trunk musclestrength is impaired multidirectionally after stroke.ClinRehabil. 1995 Feb 1;9(1):47-51.
  14. Roerdink M, Lamoth CJ, Kwakkel G, et al.: Gait coordination after stroke: benefits of acoustically paced treadmill walking. PhysTher, 2007, 87: 1009–1022.
  15. Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor ofcomprehensive activities of daily living function in stroke patients, Stroke. 2002;33:2626-2630.
  16. Dickstein r, Shefi s. Anticipatory postural adjustments in selected trunk muscles in post stroke hemiplegic patients. Arch PhysRehabil. 2004; 85(2); 261-73.
  17. Vannesjw, Nenhusi b. Posturographic assessment of sitting balance recovery in sub acute phase of stroke. Gait Posture. 2008;28(3):507-12.
  18. Verheyden G, Vereeck L, Truijen S, Troch M, HerregodtsI, Lafosse C, et al. Trunk performance after strokeand the relationship with balance, gait andfunctional ability. ClinRehabil. 2006;20(5):451-8.
  19. Tanaka s, Ogata h. Trunk rotator muscle performance in post stroke hemiplegic patients. Am J PhysioRehabili. 1997;76(5):366-69.
  20. Verheyden G, Nieuwboer A, Feys H, Thijs V, VaesK,DeWeerdt W. Discriminant ability of the TrunkImpairment Scale: A comparison between strokepatients and healthy individuals. DisabilRehabil.2005 Sep 2;27(17):1023-8.
  21. Monaco MD, Trucco M, Monaco RD, TapperoR,Cavanna A. The relationship between initial trunk control or postural balance and inpatientrehabilitation outcome after stroke: a prospective comparative study. ClinRehabil. 2010 Jun1;24(6):543–54.
  22. VanitaD’souza, Sydney RoshanRebello, NarasimmanS. Trunk performance correlates with functionaloutcome in stroke patients, Physiotherapy andOccupational Therapy Journal. April-June 2009;2(2):83-88.
  23. Davis PM. Problems associated with the loss of selectivetrunk activity in hemiplegia. Right in the Middle.Selective trunk activity in the treatment of adult hemiplegia,sixth edition. Heidelberg: Springer, 2003;31–66.
  24. Ryerson S and Levit K. Functional movement: A practicalmodel for treatment. Functional movement reeducation:a contemporary model for stroke rehabilitation.Edinburgh: Churchill Livingstone, 1997, pp.1–14.
  25. Verheyden G, Vereeck L, Truijen S, et al. Additionalexercises improve trunk performance after stroke: apilot randomized controlled trial. Neurorehabil NeuralRepair 2009; 23: 281–286.
  26. Liggett CA and Randolph M. Comparison of abdominalmuscle strength following ball and mat exercise regimens:a pilot study. J Man ManipTher1999; 7:197–202.
  27. Mackintosh SFH, Hill K, Dodd KJ, Goldie P andCulham E. Falls and injury prevention should be partof every stroke rehabilitation plan. ClinRehabil2005;19: 441–451.
  28. Segens medical dictionary, swiss ball definition, 2012
  29. AkshathaNayak, KarthikbabuS, Vijayakumar K,Does Training on Swiss Ball Improve Trunk Performance after Stroke?- A single blinded, quasiexperimental study design. Indian Journal of Physiotherapy and Occupational Therapy – AnInternational Journal. 2012;6(1):172-5.
  30. Gregory J Lehman, Trish Gordon, Jo Langley, Patricia Pemroseand Sara Tregaskis.Replacing a Swiss ball for an exercise bench causes variable changes in trunk muscle activity during upper limb strength exercises.Dynamic Medicine 2005, 4:6doi:10.1186/1476-5918-4-6.
  31. BeateCarriere& Renate tanzberger; THE SWISS BALL theory, basic    exercises and clinical application ;springerverlag publication ,January1998,AvailablefromURL-www.palmer.edu/pcc%5Flibrary/nexus/15%2820%29.htmThe ‘Swiss ball’: an effective tool in physiotherapy for patients, families and physiotherapists. . B Carrière.Physiotherapy October 1999; 85(10): 552-61.
  32. Nuzzojl, mc caulley. Trunk muscle activity during stability ball and free weight exercises. j strength Cond Res. 2008; 22(1): 95-102.
  33. Lehman G, HodaWand Oliver S. Trunk muscle activityduring bridging exercises on and off a swissball.Chiropractic Osteopathy 2005; 13: 14.
  34. Marshall PW and Murphy BA. Core stability exerciseson and off a Swiss ball. Arch Phys Med Rehabil2005; 86:242–249.
  35. Duncan M. Muscle activity of the upper and lowerrectusabdominis during exercises performed onand off a Swiss ball. J BodywMovTher. 2009Oct;13(4):364-7.
  36. Karthikbabu S, Nayak A, Vijayakumar K, Misri ZK,Suresh BV, Ganesan S, et al. Comparison of physioball and plinth trunk exercises regimens on trunkcontrol and functional balance in patients with acute stroke: a pilot randomized controlled trial.ClinRehabil. 2011 Aug 1;25(8):709-19.
  37. Cosio-lima LM , Jones MT , Paolone, Winter CR , Effects of a physioball training program on trunk and abdominal strength  and static balance measures . Medicine And Science  in Sports and Exercise . 2001; 33(5):p8325.
  38. Horak , FB: Postural orientation & equilibrium : what do we need to know about neural control of balance to prevent falls? Age Ageing 35(suppl 2):ii7-ii11,2006.
  39. KothalankaViswaja, KiranPrakashPappala, Pilladi R Sri Tulasi, &PatchavaApparao. EFFECTIVENESS OF TRUNK TRAINING EXERCISES VERSUS SWISS BALL EXERCISES FOR IMPROVING SITTING BALANCE AND GAIT PARAMETERS IN ACUTE STROKE SUBJECTS. International Journal of Physiotherapy, 2015;2(6):925-932.
  40. Kuptniratsaikul V, Praditsuwan R, Assantachai P, Ploypetch T, Udompunturak S, Pooliam J. Effectiveness of simple balancing training program in elderly patients with history of frequent falls. ClinInterv Aging. 2011;6:111-7.
  41. Kazon S, Grecco LAC, Pasini H, Corrêa JCF, Christovão TCL, De Carvalho PT, Giannasi LC, Lucareli PRG, de Oliveira LVF, Salgado ASI. Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: study protocol for prospective, randomized, controlled trial. BMC Pediatr 2012; 12(1):53.
  42. Kembhavi G, Darrah J, Magill-Evans J, Loomis J. Using the Berg Balance Scale to distinguish balance abilities in children with cerebral palsy. Pediatr. Phys. Ther 2002; 14(2):92-99.
  43. Podsiadlo D, Richardson S. The Time “Up& Go”: A Test Of Basic Functional Mobility For Frail Elderly Persons. Journal of American Geriatrics Society 1991; 39(2): 142148.
  44. Shumway Cook A, Brauer S, WoollacottM.Predicting The Probability For Falls In Community Dwelling Older Adults Using The Timed Up & Go Test. Physical Therapy 2000; 80(9): 896903.
  45. Lusardi MM, Pellecchia GL, Schulman M.Functional Performance In Community Living Older Adults. Journal Of Geriatric Physical Therapy 2003;26(3):14-22.
  46. Saskatoon Falls Prevention Consortium, Falls Screening  And Referral Algorithm ,TUG, Saskatoon Falls Prevention Consortium, June 2005
  47. Felix Renald, J. Raja Regan. EFFICACY OF TRUNK EXERCISES ON SWISS BALL VERSUS BED IN IMPROVING TRUNK CONTROL IN HEMIPARETIC PATIENTS. Int J Physiother Res 2016;4(2):1444-1450. DOI: 10.16965/ ijpr.2016.115
  48. Das J , Raja R , Vedavathi R, A Study to asses the effectiveness of trunk rehabilitation programme on Trunk control & Balance in acute ishaemic hemiparetic stroke patients: IOSR( JDMS’2016;15(12):72-81.
  49. Lima LM, Reynolds KL, Winter C ,Paolone V, Jones MT, Effect of physioball & conventional floor exercises on early phase adaptations in back and abdominal core stability & balance in women: JOU of strength and conditioning RES 2003;17(4):721-725.
  50. Stevens vk, bouche kg. Trunk muscle activity in healthy subjects during bridging stabilization exercises. bmc musculoskeletal disorder. 2006;7:75.
  51. Navaltajw: core stabilization exercises enhance lactate clearance. J Strength Cond Res. 2007;21(4):1305-9.
  52. Laurence ZR, Karen RJ, Peggy RT, Loy S, Harker JO, Pietruszkan FM, Robbins AS; Effects of a group exercise program on strength, mobility and fall among Fall-prone elderly men; Jou of Geront, 2000; 55(6).
  53. Ganvir S, Shinde S, Effect of swiss ball training on trunk performance in patients with stroke: ROM JOU of PT: VOL 20/ NR 34/ 2014/97-107.
  54. Gadhvi B et al , International Journal of Therapies and Rehabilitation Research 2016; 5 (4): 33-38.
  55. Duarte E., Marco J., Muniese, R. Belmonte, P. Diaz, M. Tejero, et al., “Trunk Control Test as a Functional Predictor in Stroke,” Journal of Rehabilitation Medicine, 2002;34(6):267-272.
  56. Verheyden, A. Nieuwboer, L. de Wit, H. Feys, B. Schuback, I. Baert, et al. Trunk Performance after Stroke: An Eye Catching Predictor of Functional Out-come. Journal of Neurology Neurosurgery and Psychiatry,2007;78(7):694-698.
  57. Verheyden, L. Vereeck, S. Truijen, M. Troch, I. Herregodts, C. Lafosse, et al., Trunk Performance after Stroke and Relationship with Balance, Gait and Functional Ability. Clinical Rehabilitation, 2006;20(5):451-458.
  58. A. Goldie, T. A. Matyas and O. M. Evans. Gait after Stroke: Initial Deficit and Changes in Temporal Patterns for each Gait Phase. Archives of Physical Medicine and Rehabilitation, 2001;82(8):1057-1065. doi:10.1053/apmr.2001.25085
  59. J. Liaw, C. L. Hsieh, S. K. Lo, H. M. Chen, S. Lee and J. H. Lin. The Relative and Absolute Reliability of Two Balance Performance Measures in Chronic Stroke Patients. Disability and Rehabilitation, 2008;30(9):656-661. doi:10.1080/09638280701400698

Cite this article: Kanika D. Muniyar, Shrikant B. Darade. EFFECT OF SWISS BALL TRAINING AND CONVENTIONAL PHYSIOTHERAPY TO IMPROVE BALANCE AND MOBILITY IN POST-STROKE PATIENTS. Int J Physiother Res 2018;6(3):2813-2822. DOI: 10.16965/ijpr.2018.156