The impact of dynamic neuromuscular stabilization on postural control and balance in post-stroke patients with sarcopenia

Rationale: The coexistence of stroke and sarcopenia increases the risk of functional decline, falls, and disability. Dynamic Neuromuscular Stabilization (DNS) emphasizes diaphragmatic breathing, intra-abdominal pressure (IAP) regulation, and coordinated stabilizer activity; however, its role in post-stroke patients with sarcopenia remains uncertain. Patient concerns: The patient presented with significant balance impairment, a heightened fear of falling, and impaired coordinated movement of the right upper and lower limbs, resulting in substantial limitations in activities of daily living and reduced functional independence. Diagnoses: The patient met EWGSOP2 criteria for confirmed post-stroke sarcopenia. Interventions: The patient received a structured 5-week adjunctive DNS protocol (3 30-minute sessions per week) alongside conventional rehabilitation, progressing from supine diaphragmatic breathing and IAP generation through positional transitions (side-lying, prone, quadruped) to standing exercises. The protocol targeted diaphragmatic breathing, IAP generation, trunk stabilization, and movement dissociation across progressive developmental positions. Outcomes: Within-case pre-post changes were observed in balance (Berg Balance Scale: 35–42), trunk control (Trunk Impairment Scale: 17–20), functional mobility (Timed Up and Go: 47–28 seconds), non-hemiplegic grip strength (15–20 kg), and lower-limb functional strength (30-second Chair Stand Test: 6–11). The observed BBS, Trunk Impairment Scale, Timed Up and Go, grip-strength, and 30s-CST changes met or exceeded selected published minimal clinically important difference (MCID) estimates, but those 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 Sarcopenia and Quality of Life questionnaire change exceeded a published 7.35-point smallest detectable change, which indicates change beyond measurement error rather than an MCID. Lessons: This single-case report suggests that adjunctive DNS was feasible and well tolerated and was temporally associated with improved postural control and functional outcomes. These observations cannot establish a DNS-specific causal effect and should be tested in controlled studies.