Improved upper limb functionality after Abdominal Drawing-in maneuver in chronic stroke survivors: a crossover study

Effective trunk control is important for coordinating upper limb movements in stroke survivors. However, quantitative evidence for trunk control interventions remains scarce.

To assess the effectiveness of Abdominal Drawing-In Maneuver (ADIM) compared to Transcutaneous Electrical Nerve Stimulation (TENS) in improving upper limb functional movements in stroke survivors.

This study utilized a crossover design to investigate the effects of ADIM versus TENS in chronic stroke survivors with a sample size of 16. Each intervention was administered at the clinic for 4 weeks in a randomized sequence, with two 40-minute sessions per week, incorporating a washout period between treatments. ADIM consisted of pressure-biofeedback-guided transversus abdominis activation, whereas the TENS comparator consisted of 20 minutes of TENS applied to the affected area, combined with upper extremity stretching, trunk rotation, and anterior - posterior pelvic movements. The main outcome measure was the kinematics of the affected arm in three directions. Independent t-test was used for carryover and period effects. A mixed-model analysis of variance with Bonferroni post hoc tests determined significant treatment effects.

ADIM compared with TENS demonstrated improvements in the movement unit (p = .02, 95% confidence interval [CI]: -3.43, -0.35), and trunk displacement (p = .04, 95% CI [-119.94, -3.36]). Additionally, ADIM showed a significant within-subject difference in elbow extension (p < .01, 95% CI [-22.25, -3.71]) in the forward direction.

ADIM suggests potential benefits for upper functional movement improvement in upper limb kinematic performance. These findings emphasize the role of deep core muscles and the efficiency of ADIM in enhancing trunk control.