{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:21:19Z","timestamp":1792790479604,"version":"4.5.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-stroke rehabilitation is often delivered in a fragmented manner across disciplines, with respiratory function routinely overlooked. This oversight represents a significant gap in comprehensive stroke management, potentially limiting functional recovery, and undermining efforts to deliver truly integrated, patient-centered rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to provide empirical evidence supporting the integration of pulmonary assessment into multidisciplinary stroke rehabilitation by examining, in stroke survivors, the associations between standard pulmonary function parameters and key functional domains, including objective measures of balance, lower-limb motor function, and trunk stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this observational study, 46 patients with stroke underwent comprehensive assessments, which included pulmonary function [percent predicted vital capacity (VC%), inspiratory capacity (IC%), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), ratio of FEV1 to FVC (FEV1\/FVC), peak expiratory flow (PEF%), maximum voluntary ventilation (MVV%)], the Berg Balance Scale (BBS), the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), the Trunk Impairment Scale (TIS), and plantar pressure analysis [center of pressure (COP) path length, COP velocity, and 95% confidence ellipse area].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this exploratory analysis, the BBS and FMA-LE scores showed positive correlations with VC%, FEV1%, and PEF% (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.30\u20130.48,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). TIS scores were positively associated with multiple pulmonary parameters (VC%, IC%, FVC%, FEV1%, FEV1\/FVC, PEF%, MVV%;\n                      <jats:italic>r<\/jats:italic>\n                      = 0.31\u20130.54,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05), with the strongest exploratory correlation observed with PEF% (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.54,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Furthermore, PEF% was negatively correlated with COP path length and velocity (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      = \u22120.30 to \u22120.33,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). The 95% confidence ellipse area was negatively correlated with IC% (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      = \u22120.40,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01) and PEF% (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      = \u22120.34,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results support the integration of simple, low-cost pulmonary screening, particularly PEF measurement, into stroke rehabilitation workflows. Such integration can act as a practical trigger for timely multidisciplinary collaboration among general practitioners, respiratory therapists, and rehabilitation specialists, thereby fostering a more cohesive, proactive approach to improving long-term functional trajectories in stroke survivors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1827402","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:41:43Z","timestamp":1781757703000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between pulmonary function and balance, motor function, and trunk stability in stroke survivors"],"prefix":"10.3389","volume":"13","author":[{"given":"Shuai","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anming","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD006185","DOI":"10.1002\/14651858.CD006185.pub5","article-title":"Electromechanical-assisted training for walking after stroke","volume":"10","author":"Mehrholz","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.3390\/brainsci11111493","article-title":"Effect of 6-week balance exercise by real-time postural feedback system on walking ability for patients with chronic stroke: a pilot single-blind randomized controlled trial","volume":"11","author":"Komiya","year":"2021","journal-title":"Brain Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.gaitpost.2017.03.004","article-title":"Trunk biomechanics during hemiplegic gait after stroke: a systematic review","volume":"54","author":"Van Criekinge","year":"2017","journal-title":"Gait Posture."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1132335","DOI":"10.3389\/fnins.2023.1132335","article-title":"Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: a review","volume":"17","author":"Liu","year":"2023","journal-title":"Front Neurosci."},{"key":"B5","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1002\/pri.1547","article-title":"Comparative lung function performance of stroke survivors and age-matched and sex-matched controls","volume":"18","author":"Ezeugwu","year":"2013","journal-title":"Physiother Res Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"5317","DOI":"10.26355\/eurrev_201808_15732","article-title":"Correlation between peripheral skeletal muscle functions and the stable phase of COPD in older patients","volume":"22","author":"Zhang","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00408-014-9626-1","article-title":"Correlations between small airway function, ventilation distribution, and functional exercise capacity in COPD patients","volume":"192","author":"Lopes","year":"2014","journal-title":"Lung."},{"key":"B8","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1589\/jpts.30.700","article-title":"The effect of respiratory exercise on trunk control, pulmonary function, and trunk muscle activity in chronic stroke patients","volume":"30","author":"Lee","year":"2018","journal-title":"J Phys Ther Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e19337","DOI":"10.1097\/MD.0000000000019337","article-title":"Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria \u2013 a prospective randomized trial","volume":"99","author":"Liaw","year":"2020","journal-title":"Medicine."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1183\/09031936.00080312","article-title":"Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations","volume":"40","author":"Quanjer","year":"2012","journal-title":"Eur Respir J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/S1836-9553(13)70161-9","article-title":"The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review","volume":"59","author":"Downs","year":"2013","journal-title":"J Physiother."},{"key":"B12","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1191\/0269215504cr733oa","article-title":"The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke","volume":"18","author":"Verheyden","year":"2004","journal-title":"Clin Rehabil."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e22425","DOI":"10.1097\/MD.0000000000022425","article-title":"Effects of visual feedback balance training with the Pro-kin system on walking and self-care abilities in stroke patients","volume":"99","author":"Zhang","year":"2020","journal-title":"Medicine."},{"key":"B14","doi-asserted-by":"publisher","first-page":"6273","DOI":"10.1109\/EMBC46164.2021.9629668","article-title":"Correlation between poststroke balance function and brain symmetry index in sitting and standing postures","volume":"2021","author":"Wang","year":"2021","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1080\/10749357.2019.1661699","article-title":"Effect of proprioceptive stimulation induced by footplate during center of pressure movement tracking training on the balance abilities of patients with chronic hemiplegic stroke: a randomized, controlled, pilot study","volume":"27","author":"Cha","year":"2020","journal-title":"Top Stroke Rehabil."},{"key":"B16","doi-asserted-by":"publisher","first-page":"6615","DOI":"10.3390\/ijerph18126615","article-title":"The effectiveness of additional core stability exercises in improving dynamic sitting balance, gait and functional rehabilitation for subacute stroke patients (CORE-Trial): study protocol for a randomized controlled trial","volume":"18","author":"Cabanas-Vald\u00e9s","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1054\/math.1999.0169","article-title":"Is there a role for transversus abdominis in lumbo-pelvic stability?","volume":"4","author":"Hodges","year":"1999","journal-title":"Man Ther."},{"key":"B18","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1152\/jappl.1997.83.3.753","article-title":"Contractions of specific abdominal muscles in postural tasks are affected by respiratory maneuvers","volume":"83","author":"Hodges","year":"1997","journal-title":"J Appl Physiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/j.1469-7793.1997.539bb.x","article-title":"Contraction of the human diaphragm during rapid postural adjustments","volume":"505","author":"Hodges","year":"1997","journal-title":"J Physiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/1520-6777(","article-title":"Co-activation of the abdominal and pelvic floor muscles during voluntary exercises","volume":"20","author":"Sapsford","year":"2001","journal-title":"Neurourol Urodyn."},{"key":"B21","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1093\/ptj\/77.2.132","article-title":"Contraction of the abdominal muscles associated with movement of the lower limb","volume":"77","author":"Hodges","year":"1997","journal-title":"Phys Ther."},{"key":"B22","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1113\/jphysiol.2001.012648","article-title":"Postural activity of the diaphragm is reduced in humans when respiratory demand increases","volume":"537","author":"Hodges","year":"2001","journal-title":"J Physiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2040","DOI":"10.1249\/MSS.0000000000000994","article-title":"Diaphragm contractility in individuals with chronic ankle instability","volume":"48","author":"Terada","year":"2016","journal-title":"Med Sci Sports Exerc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s005860050192","article-title":"Lumbar spine stability can be augmented with an abdominal belt and\/or increased intra-abdominal pressure","volume":"8","author":"Cholewicki","year":"1999","journal-title":"Eur Spine J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12877-023-04647-x","article-title":"Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study","volume":"24","author":"Li","year":"2024","journal-title":"BMC Geriatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e1985","DOI":"10.1002\/pri.1985","article-title":"The relationship of respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in post-stroke hemiplegic patients","volume":"28","author":"Boz","year":"2023","journal-title":"Physiother Res Int."},{"key":"B27","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s10072-024-07750-y","article-title":"Investigating the relationship of trunk and postural control with pulmonary functions in subacute stroke patients","volume":"46","author":"Ozhan","year":"2025","journal-title":"Neurol Sci."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1177\/1352458510378126","article-title":"The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies","volume":"16","author":"Freeman","year":"2010","journal-title":"Mult Scler."},{"key":"B29","doi-asserted-by":"publisher","first-page":"882","DOI":"10.3390\/brainsci12070882","article-title":"Assessment of diaphragm in hemiplegic patients after stroke with ultrasound and its correlation with extremity motor and balance function","volume":"12","author":"Liu","year":"2022","journal-title":"Brain Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1589\/jpts.28.107","article-title":"Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients","volume":"28","author":"Oh","year":"2016","journal-title":"J Phys Ther Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s00221-002-1040-x","article-title":"Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration","volume":"144","author":"Hodges","year":"2002","journal-title":"Exp Brain Res."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1827402\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:41:51Z","timestamp":1781757711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1827402\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":31,"alternative-id":["10.3389\/fmed.2026.1827402"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1827402","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"article-number":"1827402"}}