A 5-week adjunctive Dynamic Neuromuscular Stabilization protocol was feasible and well tolerated and was temporally associated with improved postural control and functional outcomes in a post-stroke patient with sarcopenia, though these observations cannot establish a DNS-specific causal effect.
Key Findings
Results
Balance scores improved from pre- to post-intervention as measured by the Berg Balance Scale.
Berg Balance Scale score increased from 35 to 42 points over the 5-week intervention period.
The change of 7 points met or exceeded selected published minimal clinically important difference (MCID) estimates for the BBS.
MCID estimates were derived from different stroke phases or other populations and are used 'only as contextual comparators, not as proof of clinical importance in chronic stroke with sarcopenia.'
The patient presented with significant balance impairment and heightened fear of falling at baseline.
Results
Trunk control improved from pre- to post-intervention as measured by the Trunk Impairment Scale.
Trunk Impairment Scale score increased from 17 to 20 points over the 5-week intervention.
The observed change met or exceeded selected published MCID estimates for the Trunk Impairment Scale.
These MCID estimates were derived from different populations and are used only as contextual comparators.
Results
Functional mobility improved substantially as measured by the Timed Up and Go test.
Timed Up and Go performance improved from 47 seconds to 28 seconds, a reduction of 19 seconds.
The observed change met or exceeded selected published MCID estimates for the TUG in stroke populations.
MCID estimates used were derived from different stroke phases or other populations.
Results
Non-hemiplegic grip strength increased over the course of the intervention.
Non-hemiplegic grip strength improved from 15 kg to 20 kg, an increase of 5 kg.
The patient met EWGSOP2 criteria for confirmed post-stroke sarcopenia at baseline.
The observed grip strength change met or exceeded selected published MCID estimates, though these were derived from different populations.
Results
Lower-limb functional strength improved as measured by the 30-second Chair Stand Test.
30-second Chair Stand Test repetitions increased from 6 to 11 over the 5-week protocol.
The observed change met or exceeded selected published MCID estimates for the 30-second Chair Stand Test.
MCID estimates were derived from different populations and are used only as contextual comparators.
Results
Quality of life related to sarcopenia improved beyond the threshold of measurement error.
The Sarcopenia and Quality of Life (SarQoL) questionnaire change exceeded a published 7.35-point smallest detectable change (SDC).
The authors note this 'indicates change beyond measurement error rather than an MCID.'
The SDC threshold used was derived from published literature; no MCID for this instrument was cited.
Methods
The DNS protocol was structured as a progressive 5-week adjunctive rehabilitation program delivered alongside conventional rehabilitation.
The protocol consisted of 3 sessions of 30 minutes per week for 5 weeks.
Progression moved from supine diaphragmatic breathing and intra-abdominal pressure (IAP) generation through positional transitions including side-lying, prone, and quadruped positions to standing exercises.
The protocol targeted diaphragmatic breathing, IAP generation, trunk stabilization, and movement dissociation across progressive developmental positions.
DNS was delivered as an adjunct to, not a replacement for, conventional rehabilitation.
Background
The patient presented with confirmed post-stroke sarcopenia meeting EWGSOP2 diagnostic criteria alongside significant functional limitations.
The patient met EWGSOP2 criteria for confirmed post-stroke sarcopenia.
Presenting impairments included significant balance impairment, heightened fear of falling, and impaired coordinated movement of the right upper and lower limbs.
These deficits resulted in substantial limitations in activities of daily living and reduced functional independence.
The coexistence of stroke and sarcopenia increases the risk of functional decline, falls, and disability.
Conclusions
The authors explicitly acknowledge that this single-case report cannot establish a DNS-specific causal effect and that the findings require testing in controlled studies.
The authors state: 'These observations cannot establish a DNS-specific causal effect and should be tested in controlled studies.'
The design is described as a within-case pre-post comparison, lacking a control condition.
Observed improvements were described as 'temporally associated' with the DNS protocol rather than causally attributed to it.
The role of DNS in post-stroke patients with sarcopenia is characterized as 'uncertain' in the background.
What This Means
This research describes a single patient case in which a person who had experienced a stroke and also had sarcopenia (a condition involving loss of muscle mass and strength) underwent a 5-week exercise program called Dynamic Neuromuscular Stabilization (DNS) in addition to their regular rehabilitation. DNS focuses on controlled breathing techniques, building internal abdominal pressure, and progressively challenging the body's core stabilizing muscles through a series of positions and movements. The patient showed improvements across several measures: better balance and trunk control scores, faster performance on a mobility test (cutting the Timed Up and Go time from 47 to 28 seconds), stronger grip, more chair stands in 30 seconds, and better self-reported quality of life related to sarcopenia.
The size of many of these improvements met or exceeded benchmarks (called minimal clinically important differences) that researchers use to judge whether a change is meaningful in daily life, though the authors are careful to note those benchmarks came from different patient groups and cannot be directly applied here. The quality-of-life change exceeded the threshold needed to confirm the improvement was not just measurement error. The DNS sessions were well tolerated with no reported adverse events.
This research suggests that adding DNS to standard stroke rehabilitation may be a feasible and tolerable approach that could help address both the balance problems caused by stroke and the muscle weakness associated with sarcopenia. However, because this is only a single case report with no comparison group, it is impossible to know whether DNS itself caused the improvements or whether they would have happened anyway through other aspects of rehabilitation or natural recovery. The authors call for controlled clinical trials to properly test whether DNS provides benefits beyond standard care for this population.
Zhuang J, Duhova D, Song L, Jin J, Meng T, Sun M, et al.. (2026). The impact of dynamic neuromuscular stabilization on postural control and balance in post-stroke patients with sarcopenia: A case report.. Medicine. https://doi.org/10.1097/MD.0000000000050639