Core muscle rehabilitation during early mobilization after stroke: a narrative review and clinical framework

This narrative review clarifies the clinical framework for trunk- or core-focused rehabilitation after stroke, with particular attention to the early rehabilitation period. It distinguishes between preparatory bed-level exercise and true early mobilization.

This narrative review selectively synthesizes recent reviews, consensus statements, randomized controlled trials, and cohort studies to inform clinical statements on early mobilization, trunk training, balance, falls, dysphagia, and clinical safety. Supplementary clinical reports are included primarily to illustrate practical exercise content and implementation patterns, rather than to form the primary basis for strong recommendations.

This review distinguishes upright early mobilization from preparatory bed-level trunk activation. Fixed hyperacute dose prescriptions are not supported by current evidence; core training is positioned as an adjunct to, rather than a substitute for, evidence-based functional training. Statements on falls and dysphagia are framed with greater caution. Table presents a pragmatic clinical decision-support framework, with acknowledged limitations in formal validation. Individualization according to age, stroke severity, stroke subtype, neurological status, and hemodynamic tolerance is consistently emphasized.

Core muscle rehabilitation can be integrated into early stroke rehabilitation once patients achieve medical and neurological stability. The current evidence most strongly supports its efficacy for improving trunk control and balance; recommendations regarding dosage, direct fall prevention, and specific benefits for dysphagia should remain individualized and conservative.