# Effect of Diagonal Pattern Training on Trunk Function, Balance, and Gait in Stroke Patients
## 4 Discussion  
This study was conducted to investigate the effect of diagonal pattern training on the trunk control, balance, and gait ability of stroke patients. As a result of the study, the experimental group that underwent the four-week diagonal pattern training showed significantly improved TIS scores, BBS scores, and gait parameters than the control group that received single-plane training. The TIS score showed increases in the experimental group when compared to the control group. The trunk performance including movements such as symmetrical trunk rotation, flexion, extension, lateral bending, and rotation movement is required to improve the TIS score [18]. Previous studies have demonstrated the single-plane training to show the effect of exercise on a single plane such as trunk flexion, extension, and rotation movements [3, 23]. However, diagonal pattern movements simultaneously performed the flexion, lateral bending, and rotation movements, resulting in a greater range of motion and participation of various muscles. It is notable that the diagonal pattern movement conducted in our study is a movement made based on the PNF technique and consists of repeated chopping and lift [13]. In a previous study, the chopping and lifting technique of the PNF significantly increased the TIS of stroke patients [24]. These results are consistent with our findings. Thus, the diagonal pattern training can be regarded as more efficient than single-plane training. The BBS score showed increases in the experimental group compared to the control group. BBS is widely used to evaluate the ability to maintain balance during functional activities [19, 25]. In 2015, [PERSON] et al., reported that the total TIS score correlated with BBS positively and 10 m walking negatively [26]. In 2019, [PERSON] et al. reported that the TIS showed a strong correlation with BBS and the selective trunk muscles exercise in the sitting posture can be regarded as improving the BBS score due to its use of the leg muscles [25]. According to these reports, our increased BBS score correlated with an increased TIS score which increased by diagonal pattern training to improve the trunk ability. The gait parameters such as speed and stride length showed increases in the experimental group when compared to the control group. The diagonal pattern movement conducted in this study induced separate movement of the thorax and pelvis through a diagonal downward trunk rotation and a diagonal upward trunk rotation using the upper trunk and lower trunk [27]. Stroke patients \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Classification** & \multicolumn{2}{c}{**Experimental Group (n = 21)**} & \multicolumn{2}{c}{**Control Group (n = 21)**} & \multicolumn{1}{c}{**F**} & \multicolumn{1}{c}{\(p\)} \\ \hline  & Before & After & Before & After & & \\ Cadence (step/min) & 69.28 \(\pm\) 10.40 & 79.18 \(\pm\) 15.28 [1, 2] & 70.00 \(\pm\) 11.40 & 72.63 \(\pm\) 12.40 [1] & 13.167 & 0.01 *a \\ Speed (m/s) & 0.61 \(\pm\) 0.10 & 0.74 \(\pm\) 0.12 [1, 2] & 0.61 \(\pm\) 0.11 & 0.67 \(\pm\) 0.13 [1] & 22.268 & 0.01 *a \\ Stride length (m) & 0.77 \(\pm\) 0.22 & 0.85 \(\pm\) 0.26 [1, 2] & 0.78 \(\pm\) 0.21 & 0.81 \(\pm\) 0.19 [1] & 24.161 & 0.01 *a \\ \hline \hline \end{tabular}  
* \(p<\) 0.05, 1 There was a significant difference between before test and after (p \(<\) 0.05), 2 The experimental group improved more than the control group (interaction),
* Analyzed by two-way repeated measures ANOVA, Experimental group: diagonal pattern training group, Control group: single plane training group.  
\end{table} 
Table 6: Comparison of cadence, speed, stride length in before and after.