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Horikawa A, Amimoto K, Horikawa S, Hiramoto K, Nishio M, Yoshino J, Ikeda Y. Effects of galvanic vestibular stimulation on postural righting reactions in hemiplegia. Neurosci Lett 2024; 827:137735. [PMID: 38513935 DOI: 10.1016/j.neulet.2024.137735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Patients with post-stroke hemiplegia often exhibit reduced ability to maintain sitting balance, a crucial factor for predicting prognosis. Galvanic vestibular stimulation (GVS) influences postural control by stimulating vestibular organ. Although several studies have focused on GVS in static postures, no studies have demonstrated the influence of GVS on righting reactions. Therefore, we aimed to investigate the effects of GVS on postural righting reactions in seated patients with stroke-induced hemiplegia. Using a vertical board (VB), righting reactions were induced by tilting the VB at 10° after patients sat for 1 min. Patients adjusted their bodies until feeling vertical upon prompt. Twenty-two left hemiplegic patients with cerebrovascular disease participated, divided into two groups undergoing right cathode GVS (RC-GVS) followed by left cathode GVS or vice versa, preceded by sham stimulation. Centre of pressure and the joint angle were measured. During the postural righting reactions towards the paralysed side, RC-GVS enhanced the righting reactions and moved the mean position on the x-axis (COPx) to the right and the mean position on the y-axis (COPy) to the front. During the postural righting reaction towards the right side, RC-GVS induced resistance against the righting reaction, COPx was deflected to the right, COPy was deflected backward, and the angle of the neck tilt increased. The findings revealed that GVS with anodal stimulation on the paralysed side could promote righting reactions in patients with post-stroke hemiplegia. SIGNIFICANCE STATEMENT: The study findings suggest that using the contralesional placement of the anode promotes righting reactions, and galvanic vestibular stimulation can induce joint movements in the neck and trunk by polarising it to act as resistance against righting reactions.
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Affiliation(s)
- Akari Horikawa
- Department of Rehabilitation, Kitahara Rehabilitation Hospital, 461 Sanyumachi, Hachioji-shi, Tokyo, 192-0012, Japan; Department of Physical Therapy, Faculty of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
| | - Shota Horikawa
- Department of Rehabilitation, Kitahara Rehabilitation Hospital, 461 Sanyumachi, Hachioji-shi, Tokyo, 192-0012, Japan
| | - Ken Hiramoto
- Department of Rehabilitation, Kitahara Rehabilitation Hospital, 461 Sanyumachi, Hachioji-shi, Tokyo, 192-0012, Japan.
| | - Masaki Nishio
- Department of Rehabilitation, Kitahara Rehabilitation Hospital, 461 Sanyumachi, Hachioji-shi, Tokyo, 192-0012, Japan.
| | - Jun Yoshino
- Department of Rehabilitation, Kitahara Rehabilitation Hospital, 461 Sanyumachi, Hachioji-shi, Tokyo, 192-0012, Japan
| | - Yumi Ikeda
- Department of Physical Therapy, Faculty of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
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Ghazavi Dozin SM, Mohammad Rahimi N, Aminzadeh R. Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Biol Res Nurs 2024; 26:5-20. [PMID: 37247514 DOI: 10.1177/10998004231180316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. METHODS We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. OBJECTIVE To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. RESULTS 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. CONCLUSION Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.
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Affiliation(s)
| | | | - Reza Aminzadeh
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
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Mascarenhas R, Nayak A, Joshua AM, Krishnan SK, Iyer VLR, Tedla JS, Reddy RS. Oblique direction reach test: evaluating psychometric properties in stroke population. PeerJ 2023; 11:e16562. [PMID: 38077435 PMCID: PMC10710166 DOI: 10.7717/peerj.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
Background Post-stroke individuals are observed to have reduced limits of stability (LOS) in all directions. Functional activities are rarely performed in pure cardinal planes; instead, they are most likely to be performed in an oblique direction. Existing tools are either expensive or sophisticated to assess the LOS in an oblique direction. Therefore, this study's primary objective is to evaluate the intra-rater, inter-rater reliability, and validity of the oblique direction reach test (ODRT) among stroke subjects. Materials & Methods A total of 96 first-time stroke patients with age, gender, height, and weight-matched healthy controls aged 18-80 years were recruited for the study. Oblique, forward, and lateral reach distances were assessed using the standard procedure of ODRT, Functional Reach Test (FRT), and Lateral Reach Test (LRT), respectively. Validity was tested by correlating the ODRT distance with the Berg Balance Scale (BBS) Score using Spearman's rank correlation coefficient. Intraclass correlation coefficients (ICCs) and Bland Altman analysis were used to establish inter-rater reliability. ICCs were used to find intra-rater reliability. The Mann-Whitney U test was used to establish the mean difference of the FRT, LRT, and ODRT. Spearman's rank correlation coefficient and linear regression were used to correlate the distance of FRT and LRT with ODRT. Results A high concurrent validity was found between BBS and ODRT with an r-value of 0.905 (p < 0.001). Inter-rater reliability was high with an ICC of 0.997 (95% CI [0.996-0.998]), and intra-rater reliability was highly significant with an ICC of 0.996 (95% CI [0.994-0.998]). The stroke subjects reached a significantly shorter distance than healthy individuals in FRT, ODRT, and LRT. ODRT was highly correlated with FRT (r = 0.985) and LRT (r = 0.978) (p < 0.001) and had an R2 = 0.987. Conclusion ODRT is a highly valid and reliable tool that can be used to evaluate balance in stroke patients. Individuals who reached less in the forward and lateral directions showed reduced reach distance in the oblique direction.
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Affiliation(s)
- Rinita Mascarenhas
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Health Education, Manipal, India
| | - Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Health Education, Manipal, India
| | - Abraham M. Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Health Education, Manipal, India
| | - Shyam K. Krishnan
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Health Education, Manipal, India
| | - Vani Lakshmi R. Iyer
- Department of Data Science, Prasanna School of Public Health, Manipal, Manipal Academy of Health Education, Manipal, India
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
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Akremi H, Higgins J, Guediri A, Aissaoui R, Nadeau S. Seated postural organization during bilateral upper limb symmetric and asymmetric pushing tasks in individuals after stroke compared to healthy controls. Gait Posture 2023; 104:83-89. [PMID: 37343399 DOI: 10.1016/j.gaitpost.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Asymmetric weight distribution in sitting has been reported in people after stroke. However, postural strategies used during bilateral symmetric and asymmetric movements performed while seated require more evidence to inform rehabilitation strategies. RESEARCH QUESTIONS How do symmetric and asymmetric effort levels exerted during upper limb (UL) pushing movements affect seated postural organization parameters (weight bearing (WB) between hands and hemibody sides, and forward trunk displacement) of stroke compared to healthy individuals? How are these parameters associated? METHODS Using an instrumented exerciser, 19 post-stroke individuals were compared to 17 healthy individuals when executing four bilateral UL pushing movements in a seated position: symmetrical pushing at 30 % and 15 % of their maximal force (MF) and asymmetrical pushing with 15 % of their MF for one UL vs. 30 % of the MF for the other UL and vice versa. Anterior and vertical forces of the push, as well as vertical forces under each foot and thigh were compared between groups, sides and conditions. Forward trunk displacement was compared between groups and conditions. Correlations were used to determine the association between trunk displacement, hands and hemibody vertical forces. RESULTS Increasing pushing effort caused increased WB on thighs and decreased on WB on feet during the 30 % MF symmetric condition compared to the 15 % MF and asymmetric conditions (p < 0.05). Individuals post-stroke showed WB asymmetry and greater forward trunk displacement when compared to healthy persons (p < 0.05). For both groups, hemibody WB and trunk displacement showed moderate association (r > - 0.5) in the asymmetric condition executed with more resistance on the paretic or non-dominant hand. SIGNIFICANCE Individuals post-stroke presented a similar WB pattern to that of healthy persons during symmetric and asymmetric bilateral UL movements with greater forward trunk displacement and asymmetry. Increased effort and asymmetric force between both UL had effects on seated postural organization strategy.
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Affiliation(s)
- Haifa Akremi
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada
| | - Johanne Higgins
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada
| | - Amine Guediri
- Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada
| | - Rachid Aissaoui
- Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada; École de Technologie Supérieure (ETS) and Imaging and Orthopaedics Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Sylvie Nadeau
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Canada.
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Gular K, Sivasubramanian V, Reddy RS, Tedla JS, Dixit S. The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15644. [PMID: 36497718 PMCID: PMC9738511 DOI: 10.3390/ijerph192315644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. METHODS This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk's stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). RESULTS The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. CONCLUSIONS The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.
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Affiliation(s)
- Kumar Gular
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Viswanathan Sivasubramanian
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
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Inoue M, Amimoto K, Shida K, Sekine D, Hasegawa D, Fukata K, Fujino Y, Makita S, Takahashi H. Effects of Dynamic Sitting Exercise with Delayed Visual Feedback in the Early Post-Stroke Phase: A Pilot Double-Blinded Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12050670. [PMID: 35625055 PMCID: PMC9139189 DOI: 10.3390/brainsci12050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Sitting ability in the early post-stroke phase affects functional balance ability and other prognoses. We investigated whether dynamic sitting exercise with delayed visual feedback in the mediolateral and anteroposterior directions affected postural control in the early post-stroke phase. In this pilot randomized controlled trial, 27 hemiparetic stroke patients were randomized to experimental (n = 13) and control (n = 14) groups. Dynamic sitting exercise (30 times/day, 5 days/week) in the mediolateral and anteroposterior directions, with 500-ms-delayed (experimental group) or real-time (control group) visual feedback on a computer, was added to usual physical therapy. We evaluated the postural assessment scale for stroke (PASS), static and dynamic sitting balance tasks, the five-times sit-to-stand test, trunk impairment scale, functional ambulation category, and functional independence measure−motor items. In intention-to-treat analysis, the experimental group demonstrated a significant intervention effect on the PASS score (p < 0.05). The mean percentage of body weight on the moving side in the lateral sitting task and the number of successes in the five-times sit-to-stand test were significantly higher in the experimental group than those in the control group (p < 0.05). Thus, the proposed exercise improves postural control, dynamic sitting balance, and sit-to-stand ability in early post-stroke patients.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-1211
| | - Kohei Shida
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Daichi Hasegawa
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
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Sousa ASP, Moreira J, Silva C, Mesquita I, Silva A, Macedo R, Santos R. Postural control during turn on the light task assisted by functional electrical stimulation in post stroke subjects. Sci Rep 2022; 12:6999. [PMID: 35487933 PMCID: PMC9054778 DOI: 10.1038/s41598-022-10893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Abstract
Postural control mechanisms have a determinant role in reaching tasks and are typically impaired in post-stroke patients. Functional electrical stimulation (FES) has been demonstrated to be a promising therapy for improving upper limb (UL) function. However, according to our knowledge, no study has evaluated FES influence on postural control. This study aims to evaluate the influence of FES UL assistance, during turning on the light task, in the related postural control mechanisms. An observational study involving ten post-stroke subjects with UL dysfunction was performed. Early and anticipatory postural adjustments (EPAs and APAs, respectively), the weight shift, the center of pressure and the center of mass (CoM) displacement were analyzed during the turning on the light task with and without the FES assistance. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists' and patients' perspectives. The ANOVA repeated measures, Paired sample t and McNemar tests were used to compare postural control between the assisted and non-assisted conditions. When the task was assisted by FES, the number of participants that presented APAs increased (p = 0.031). UL FES assistance during turning on the light task can improve postural control in neurological patients with UL impairments.
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Affiliation(s)
- Andreia S P Sousa
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072, Porto, Portugal.
| | - Juliana Moreira
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072, Porto, Portugal
| | - Claudia Silva
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072, Porto, Portugal
| | - Inês Mesquita
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Functional Sciences, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Augusta Silva
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072, Porto, Portugal
| | - Rui Macedo
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072, Porto, Portugal
| | - Rubim Santos
- Center for Rehabilitation Research-Human Movement System (Re)Habilitation Area, Department of Physics, School of Health, Polytechnic of Porto, Porto, Portugal
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Marchesi G, Ballardini G, Barone L, Giannoni P, Lentino C, De Luca A, Casadio M. Modified Functional Reach Test: Upper-Body Kinematics and Muscular Activity in Chronic Stroke Survivors. SENSORS (BASEL, SWITZERLAND) 2021; 22:s22010230. [PMID: 35009772 PMCID: PMC8749777 DOI: 10.3390/s22010230] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 05/06/2023]
Abstract
Effective control of trunk muscles is fundamental to perform most daily activities. Stroke affects this ability also when sitting, and the Modified Functional Reach Test is a simple clinical method to evaluate sitting balance. We characterize the upper body kinematics and muscular activity during this test. Fifteen chronic stroke survivors performed twice, in separate sessions, three repetitions of the test in forward and lateral directions with their ipsilesional arm. We focused our analysis on muscles of the trunk and of the contralesional, not moving, arm. The bilateral activations of latissimi dorsi, trapezii transversalis and oblique externus abdominis were left/right asymmetric, for both test directions, except for the obliquus externus abdominis in the frontal reaching. Stroke survivors had difficulty deactivating the contralesional muscles at the end of each trial, especially the trapezii trasversalis in the lateral direction. The contralesional, non-moving arm had muscular activations modulated according to the movement phases of the moving arm. Repeating the task led to better performance in terms of reaching distance, supported by an increased activation of the trunk muscles. The reaching distance correlated negatively with the time-up-and-go test score.
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Affiliation(s)
- Giorgia Marchesi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy; (G.B.); (P.G.); (A.D.L.); (M.C.)
- Correspondence: ; Tel.: +39-0103536550
| | - Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy; (G.B.); (P.G.); (A.D.L.); (M.C.)
| | - Laura Barone
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, 17027 Pietra Ligure, Italy; (L.B.); (C.L.)
| | - Psiche Giannoni
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy; (G.B.); (P.G.); (A.D.L.); (M.C.)
| | - Carmelo Lentino
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, 17027 Pietra Ligure, Italy; (L.B.); (C.L.)
| | - Alice De Luca
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy; (G.B.); (P.G.); (A.D.L.); (M.C.)
- Movendo Technology s.r.l., 16128 Genoa, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy; (G.B.); (P.G.); (A.D.L.); (M.C.)
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Vieira MF, Rodrigues FB, de Oliveira Assis A, de Mendonça Mesquita E, Lemes TS, De Villa GAG, Baptista RR, de Oliveira Andrade A, Lobo da Costa PH. Effects of additional load at different heights on gait initiation: A statistical parametric mapping of center of pressure and center of mass behavior. PLoS One 2021; 16:e0242892. [PMID: 34115751 PMCID: PMC8195414 DOI: 10.1371/journal.pone.0242892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to investigate the effects of different vertical positions of an asymmetrical load on the anticipatory postural adjustments phase of gait initiation. Sixty-eight college students (32 males, 36 females; age: 23.65 ± 3.21 years old; weight: 69.98 ± 8.15 kg; height: 1.74 ± 0.08 m) were enrolled in the study. Ground reaction forces and moments were collected using two force platforms. The participants completed three trials under each of the following random conditions: no-load (NL), waist uniformly distributed load (WUD), shoulder uniformly distributed load (SUD), waist stance foot load (WST), shoulder stance foot load (SST), waist swing foot load (WSW), and shoulder swing foot load (SSW). The paired Hotelling’s T-square test was used to compare the experimental conditions. The center of pressure (COP) time series were significantly different for the SUD vs. NL, SST vs. NL, WST vs. NL, and WSW vs. NL comparisons. Significant differences in COP time series were observed for all comparisons between waist vs. shoulder conditions. Overall, these differences were greater when the load was positioned at the shoulders. For the center of mass (COM) time series, significant differences were found for the WUD vs. NL and WSW vs. NL conditions. However, no differences were observed with the load positioned at the shoulders. In conclusion, only asymmetrical loading at the waist produced significant differences, and the higher the extra load, the greater the effects on COP behavior. By contrast, only minor changes were observed in COM behavior, suggesting that the changes in COP (the controller) behavior are adjustments to maintain the COM (controlled object) unaltered.
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Affiliation(s)
- Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Fábio Barbosa Rodrigues
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
- State University of Goiás – Unidade Trindade-GO, Brazil
| | | | | | - Thiago Santana Lemes
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
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10
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Relation Between Reach Distance and Center of Pressure Distance for Multidirectional Reach in Hemiplegic Patients. J Stroke Cerebrovasc Dis 2021; 30:105709. [PMID: 33774552 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sitting balance training is an important therapy used by physical and occupational therapists who work with hemiplegic patients. Objective This study compared reach distance (Rd) and center of pressure distance (COPd) for postural control during a multidirectional reaching task in 26 patients with hemiplegia. Method Following the evaluation of trunk function, we classified subjects according to their Chedoke-McMaster assessment stage: group A, stages 5 and 6; group B, stage <4. We used a functional reach apparatus with a body pressure distribution measurement system and a video camera to measure Rd and COPd. Subjects performed multidirectional reaching tasks in the forward/front direction and toward the nonparetic and paretic sides. Resuts Group A showed moderately strong to strong positive correlations between Rd and COPd in all directions, particularly in the forward/front direction. Group B showed lower correlations between Rd and COPd, particularly during tasks where reach was directed toward the paretic side. Conclusion These results suggest that differences in trunk function had an effect on Rd and COPd during multi-directional reaching task.
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11
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Effects of Virtual Reality-Based Therapy on Quality of Life of Patients with Subacute Stroke: A Three-Month Follow-Up Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062810. [PMID: 33801969 PMCID: PMC7999196 DOI: 10.3390/ijerph18062810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 03/06/2021] [Indexed: 12/13/2022]
Abstract
Objective: To evaluate the influence of conventional rehabilitation combined with virtual reality on improving quality of life related to post-stroke health. Design: Randomized controlled trial. Setting: Rehabilitation and neurology departments of a general hospital (Talavera de la Reina, Spain). Subjects: A total of 43 participants with subacute stroke. Intervention: Participants were randomized into experimental group (conventional treatment + virtual reality) and control (conventional treatment). Main measures: Health-related quality of life as measured by the EuroQoL-5 dimensions instrument (EQ-5D-5L) and EuroQoL visual analog scale (EQ-VAS). Results: A total of 23 patients in the experimental group (62.6 ± 13.5 years) and 20 in the control (63.6 ± 12.2 years) completed the study. In the experimental group, EQ-VAS score was 29.1 ± 12.8 at baseline, 86.5 ± 7.1 post-intervention, and 78.3 ± 10.3 at the three-month follow-up. The control group obtained scores of 25.5 ± 5.1, 57.0 ± 4.7, and 58.5 ± 5.9, respectively. We identified significant differences at the post-intervention and follow-up timepoints (p = 0.000) and a partial η2 of 0.647. In EQ-5D-5L, the severity of issues decreased after intervention in the experimental group, while pain and anxiety dimensions increased between post-intervention and follow-up. Conclusions: The conventional rehabilitative approach combined with virtual reality appears to be more effective for improving the perceived health-related quality of life in stroke survivors.
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12
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Uldahl M, Christensen JW, Clayton HM. Relationships between the Rider's Pelvic Mobility and Balance on a Gymnastic Ball with Equestrian Skills and Effects on Horse Welfare. Animals (Basel) 2021; 11:453. [PMID: 33572205 PMCID: PMC7915365 DOI: 10.3390/ani11020453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023] Open
Abstract
Riders need core stability to follow and guide the horse's movements and avoid giving unintended or conflicting signals. This study evaluated the rider's performance of exercises on a gymnastic ball with on-horse performance and indicators of stress in the horse. Twenty experienced riders were scored performing three exercises on a gymnastic ball and for quality and harmony when riding based on evaluation of video recordings in which conflict behaviours were evident. The horse's heart rate and number of conflict behaviors during the riding test and cortisol levels after completion of the test were measured. The rider's ability to roll the pelvis from side-to-side on a gymnastic ball was highly correlated with ability to circle the pelvis on the ball and with quality and harmony during riding. However, pelvic roll and riding quality and harmony showed a trend toward a negative correlation with balancing skills on the ball. It appears that the ability to actively move the pelvis is more relevant to equestrian performance than static balancing skill. Horses ridden by riders with better pelvic mobility and control showed significantly fewer conflict behaviors. On the contrary, high scores for balancing on the gymnastic ball were negatively correlated with the horses' working heart rates, suggesting a less energetic performance. Pelvic control and mobility may be predictive for equestrian skills and riding harmony.
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Affiliation(s)
- Mette Uldahl
- Vejle Hestepraksis, Fasanvej 12, 7120 Vejle, Denmark;
| | - Janne W. Christensen
- Department of Animal Science, Aarhus University, Blichers Allé 20, 8830 Tjele, Denmark;
| | - Hilary M. Clayton
- Department of Large Animal Clinical Sciences, Michigan State University, 736 Wilson Road, East Lansing, MI 48824, USA
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13
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Wiskerke E, van Dijk M, Thuwis R, Vandekerckhove C, Myny C, Kool J, Dejaeger E, Beyens H, Verheyden G. Maximum weight-shifts in sitting in non-ambulatory people with stroke are related to trunk control and balance: a cross-sectional study. Gait Posture 2021; 83:121-126. [PMID: 33129172 DOI: 10.1016/j.gaitpost.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impaired sitting balance is common in persons with stroke, affecting postural control in different directions. However, studies seldomly investigate sitting balance in severely affected non-ambulatory persons with stroke and precise assessment including the diagonal directions are scarce. RESEARCH QUESTION Are measurements of maximal voluntary weight-shifts decreased in severely affected persons with stroke in comparison to healthy controls, and is there a relationship with clinical measurements of trunk control, sitting and standing balance? METHODS 14 Persons with stroke were recruited in the rehabilitation phase along with 32 healthy controls. A clinical pressure platform (RM Ingénierie, France) evaluated the weight-distribution during static sitting and measurements of maximal voluntary weight-shifts, by centre of pressure displacements in six directions. Clinical measurements included Trunk Control Test, Trunk Impairment Scale and Berg Balance Scale. RESULTS The persons with stroke had a mean (SD) age of 69 (17) years, including 5 females and 9 males and were on average 57 (40) days post stroke. No patient was able to walk without manual support and median (IQR) Berg Balance Scale score was 17 (6-33) out of 56 points. Measurements showed that the centre of pressure distance was significantly smaller in all directions in persons with stroke compared to healthy controls (p < 0.05). The clinical measurements demonstrated moderate to very high correlations with centre of pressure distance in the diagonal forward, diagonal backward and lateral directions (r = 0.54 - 0.89). SIGNIFICANCE This study reveals that measurements of maximal voluntary weight-shifts are feasible and show clinically relevant deficits in severely affected non-ambulatory persons with stroke. Especially the lateral and diagonal directions can be of interest to investigate further as they are most strongly correlated with clinical measurements of balance. Reaching exercises in these directions could be considered a core element of rehabilitation for this group of patients.
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Affiliation(s)
- Evelyne Wiskerke
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; Rehazentrum Valens - Kliniken Valens, Valens, Switzerland, Taminaplatz 1, 7317 Valens, Switzerland.
| | - Margaretha van Dijk
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Rhea Thuwis
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Chesny Vandekerckhove
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Charlotte Myny
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Jan Kool
- Rehazentrum Valens - Kliniken Valens, Valens, Switzerland, Taminaplatz 1, 7317 Valens, Switzerland.
| | - Eddy Dejaeger
- UZ Leuven - University Hospitals Leuven, Department of Geriatrics, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Hilde Beyens
- UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
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14
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Lee HH, Lee JW, Kim BR, Jung HJ, Choi DH, Lee J. Predicting independence of gait by assessing sitting balance through sitting posturography in patients with subacute hemiplegic stroke. Top Stroke Rehabil 2020; 28:258-267. [PMID: 32783510 DOI: 10.1080/10749357.2020.1806437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-stroke sitting balance is a known predictor of independence of gait after stroke. However, previous studies used only qualitative scales or measured static or dynamic sitting balance alone. OBJECTIVES To investigate whether quantitative parameters of sitting posturography at post-stroke 1 month can predict independent gait. METHODS In this prospective cohort study, we enrolled patients with first-ever stroke who could hold a sitting posture at post-stroke 1 month. Sitting balance was assessed using posturography at post-stroke 1 month. Independence of gait was assessed using functional ambulation categories at post-stroke 2 months. We predicted mobility independence at post-stroke 2 months according to sitting balance at post-stroke 1 month. We also assessed the correlation between sitting posturography parameters and clinical scales. RESULTS We enrolled 27 patients. The limit of stability deviation predicted independent gait at post stroke 2 months (cutoff, 78.4%). Further, there was a high degree of correlation between sitting posturography parameters (weight-bearing distribution deviation and limit of stability deviation) and Berg Balance Scale (ρ = 0.763, ρ = 0.777; p < .001, respectively), Scale for Assessment and Rating of Ataxia (ρ = -0.853, ρ = -0.929; p < .001, respectively), and Fugl-Meyer Assessment scale (upper extremities: ρ = 0.520, ρ = 0.480 [p = .005, p = .011, respectively]; lower extremities: ρ = 0.744, ρ = 0.564 [p < .001, p = .002, respectively]) scores. CONCLUSIONS Sitting posturography parameters is clinically useful because they can quantitatively assess post-stroke balance and neurological impairment and predict post-stroke independence of gait even when patients cannot reach their arms forward or stand upright.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Jong Won Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Gyeongin Rehabilitation Center Hospital, Incheon, Korea
| | - Ho Joong Jung
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Dong-Hee Choi
- Center for Neuroscience Research, Institute of Biomedical Science & Technology, Konkuk University, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea.,Center for Neuroscience Research, Institute of Biomedical Science & Technology, Konkuk University, Seoul, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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15
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De Luca A, Squeri V, Barone LM, Vernetti Mansin H, Ricci S, Pisu I, Cassiano C, Capra C, Lentino C, De Michieli L, Sanfilippo CA, Saglia JA, Checchia GA. Dynamic Stability and Trunk Control Improvements Following Robotic Balance and Core Stability Training in Chronic Stroke Survivors: A Pilot Study. Front Neurol 2020; 11:494. [PMID: 32625162 PMCID: PMC7311757 DOI: 10.3389/fneur.2020.00494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/05/2020] [Indexed: 01/25/2023] Open
Abstract
Stroke survivors show greater postural oscillations and altered muscular activation compared to healthy controls. This results in difficulties in walking and standing, and in an increased risk of falls. A proper control of the trunk is related to a stable walk and to a lower falling risk; to this extent, rehabilitative protocols are currently working on core stability. The main objective of this work was to evaluate the effectiveness of trunk and balance training performed with a new robotic device designed for evaluation and training of balance and core stability, in improving the recovery of chronic stroke patients compared with a traditional physical therapy program. Thirty chronic stroke patients, randomly divided in two groups, either underwent a traditional rehabilitative protocol, or a robot-based program. Each patient was assessed before and after the rehabilitation and at 3-months follow-up with clinical and robot-based evaluation exercises focused on static and dynamic balance and trunk control. Results from clinical scores showed an improvement in both groups in balance and trunk control. Robot-based indices analysis indicated that the experimental group showed greater improvements in proprioceptive control, reactive balance and postural control in unstable conditions, compared to the control group, showing an improved trunk control with reduced compensatory strategies at the end of the training. Moreover, the experimental group had an increased retention of the benefits obtained with training at 3 months follow up. These results support the idea that such robotic device is a promising tool for stroke rehabilitation.
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Affiliation(s)
| | | | - Laura M Barone
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Honorè Vernetti Mansin
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Serena Ricci
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Ivano Pisu
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Cinzia Cassiano
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Cristina Capra
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Carmelo Lentino
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | | | | | | | - Giovanni A Checchia
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy.,Department of Rehabilitation, Local Health Agency EUGANEA, Padua, Italy
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16
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Effects of Video-Game Based Therapy on Balance, Postural Control, Functionality, and Quality of Life of Patients with Subacute Stroke: A Randomized Controlled Trial. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:5480315. [PMID: 32148744 PMCID: PMC7040403 DOI: 10.1155/2020/5480315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/10/2019] [Accepted: 01/17/2020] [Indexed: 12/18/2022]
Abstract
Purpose To determine the effects of a structured protocol using commercial video games on balance, postural control, functionality, quality of life, and level of motivation in patients with subacute stroke. Methods A randomized controlled trial was conducted. A control group (n = 25) received eight weeks of conventional rehabilitation consisting of five weekly sessions based on an approach for task-oriented motor training. The experimental group (n = 25) received eight weeks of conventional rehabilitation consisting of five weekly sessions based on an approach for task-oriented motor training. The experimental group ( Results In the between-group comparison, statistically significant differences were observed in the Modified Rankin scores (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index (p < 0.01), the Barthel Index ( Conclusion A protocol of semi-immersive video-game based therapy, combined with conventional therapy, may be effective for improving balance, functionality, quality of life, and motivation in patients with subacute stroke. This trial is registered with NCT03528395.
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17
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Kerr, Rowe, Clarke, Chandler, Smith, Ugbolue, Pomeroy. Biomechanical correlates for recovering walking speed following a stroke. The potential of tibia to vertical angle as a therapy target. Gait Posture 2020; 76:162-167. [PMID: 31862664 DOI: 10.1016/j.gaitpost.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/17/2019] [Accepted: 12/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recovering independent walking is a priority for stroke survivors. Community walking requires speeds exceeding the average values typically achieved at discharge (0.7 m/s). To improve outcomes there is a need to clarify the factors associated with recovery of functional walking speeds. RESEARCH QUESTION Which biomechanical variables correlate significantly with improved walking speed following rehabilitation in acute stroke patients. METHODS The study was embedded in a larger clinical trial testing efficacy of a gait training splint. Participants, within 6 weeks of their stroke and exhibiting abnormal gait, were recruited. Using a valid and reliable video-based system, specific kinematic measures were recorded before randomisation (baseline), after a 6-week rehabilitation phase (outcome) and six months after stroke (follow-up). Measures of temporospatial symmetry, knee angular velocity and tibia to vertical angle were added to clinical measures and correlated with change in speed. RESULTS 23 participants were recruited, (mean age 67.7 ± 16.7 years, 19.2 ± 9.0 days after stroke and 73.9% male), with 20/23 assessed at outcome and 17/23 at follow-up. Drop out was due to withdrawal (3) and technical failure (3). Walking speed increased by 0.15 ± 0.21 m/s (outcome), and 0.21 ± 0.14 m/s (follow-up) from baseline (0.50 ± 0.20 m/s). This increase correlated with an increase in step length (r=0.88) and change in angle of tibia at initial contact (r=-0.59), foot flat (r=-0.61) and terminal contact (r=0.54). SIGNIFICANCE This study of gait recovery among acute stroke patients demonstrated modest improvements in walking speed. Walking speed by follow-up (0.71 m/s) classified the group as community walkers (>0.66 m/s) but still too slow to safely use a pedestrian road crossing. Change in step length and tibia to vertical angle significantly correlated with increased walking speed. This finding provides distinctive targets for therapy aimed at improving community walking among stroke survivors. This hypothesis should be tested prospectively in future studies.
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Affiliation(s)
- Kerr
- Biomedical Engineering Dept, University of Strathclyde, Glasgow, UK.
| | - Rowe
- Biomedical Engineering Dept, University of Strathclyde, Glasgow, UK
| | - Clarke
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Chandler
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Smith
- English Institute of Sport, Sheffield, UK
| | - Ugbolue
- School of Science and Sport, University of West of Scotland, Hamilton, UK
| | - Pomeroy
- School of Health Sciences, University of East Anglia, Norwich, UK
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18
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Fukata K, Amimoto K, Inoue M, Sekine D, Inoue M, Fujino Y, Makita S, Takahashi H. Effects of diagonally aligned sitting training with a tilted surface on sitting balance for low sitting performance in the early phase after stroke: a randomised controlled trial. Disabil Rehabil 2019; 43:1973-1981. [PMID: 31714801 DOI: 10.1080/09638288.2019.1688873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To clarify the effects of diagonally aligned sitting training using a tilted surface on sitting balance for patients with low sitting performance in the early phase after stroke. MATERIALS AND METHODS This was an assessor-blinded randomised controlled trial. The experimental group used a surface tilted 10° backward and down toward the most affected side; the control group trained on a horizontal surface. Both groups were asked to move their trunk diagonally forward toward the least affected side. Participants performed the activity 40 times/session for seven sessions over 8 days. Sitting performances were assessed using the function in sitting test (FIST), subjective postural vertical (SPV) on the diagonal plane, and trunk impairment scale (TIS). RESULTS Thirty-three stroke patients were randomly allocated into two groups. Treatment effects differed significantly: mean differences between groups for FIST (total score, static, dynamic, scooting, and reactive) were 8.96, 2.35, 3.01, 1.27, and 1.72 points, for the mean SPV value was 1.82°, and for the TIS (total score and static) were 1.87 and 1.58 points, respectively. These results were more favourable in the experimental group. CONCLUSIONS Diagonally aligned sitting training on a tilted surface improves sitting balance and modulates the SPV compared with a horizontal surface.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan
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19
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Lee K, Cho JE, Hwang DY, Lee W. Decreased Respiratory Muscle Function Is Associated with Impaired Trunk Balance among Chronic Stroke Patients: A Cross-sectional Study. TOHOKU J EXP MED 2018; 245:79-88. [PMID: 29848898 DOI: 10.1620/tjem.245.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The abdominal muscles play a role in trunk balance. Abdominal muscle thickness is asymmetrical in stroke survivors, who also have decreased respiratory muscle function. We compared the thickness of the abdominal muscles between the affected and less affected sides in stroke survivors. In addition, the relationship between respiratory muscle function and trunk balance was evaluated. Chronic stroke patients (18 men, 15 women; mean age, 58.94 ± 12.30 years; Mini-Mental Status Examination score ≥ 24) who could sit without assist were enrolled. Abdominal muscle thickness during rest and contraction was measured with ultrasonography, and the thickening ratio was calculated. Respiratory muscle function assessment included maximum respiratory pressure, peak flow, and air volume. Trunk function was evaluated using the Trunk Impairment Scale, and trunk balance was estimated based on the center of pressure velocity and path length within the limit of stability in sitting posture. Abdominal muscles were significantly thinner on the affected side, and the thickening ratio was lower in the affected side (P < 0.05). In addition, the higher thickening ratio of the affected side showed significant relationship with higher trunk function. Moreover, higher respiratory muscle function was significantly correlated with higher level of trunk function and balance in stroke patients (P < 0.05). Thus, chronic stroke survivors have decreased abdominal muscle thickness on the affected side, and respiratory muscle function has positive correlation with trunk function and balance. We propose that respiratory muscle training should be included as part of trunk balance training in chronic stroke patients.
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Affiliation(s)
- Kyeongbong Lee
- Physical Therapy Part, Department of Physical and Rehabilitation Medicine, Samsung Medical Center
| | - Ji-Eun Cho
- Department of Physical Therapy, Graduate School of Sahmyook University
| | - Dal-Yeon Hwang
- Department of Physical Therapy, Myongji Choonhye Rehabilitation Hospital
| | - WanHee Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University
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20
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Silva CF, Pereira S, Silva CC, Ferreira S, Oliveira N, Santos R. Anticipatory postural adjustments in the shoulder girdle in the reach movement performed in standing by post-stroke subjects. Somatosens Mot Res 2018; 35:124-130. [DOI: 10.1080/08990220.2018.1484354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cláudia F. Silva
- Pysiotherapist graduate at the School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Soraia Pereira
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Cláudia C. Silva
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Sílvia Ferreira
- Pysiotherapist graduate at the School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Nuno Oliveira
- Department of Physics, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Rubim Santos
- Department of Physics and Activity and Human Movement Study Center (CEMAH), School of Health, Polytechnic Institute of Porto, Porto, Portugal
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21
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Perez-Cruzado D, Gonzalez-Sanchez M, Cuesta-Vargas AI. Differences in Kinematic Variables in Single-Leg Stance between Patients with Stroke and Healthy Elderly People Measured with Inertial Sensors: A Cross-Sectional Study. J Stroke Cerebrovasc Dis 2018; 27:229-239. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
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22
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De Luca A, Giannoni P, Vernetti H, Capra C, Lentino C, Checchia GA, Casadio M. Training the Unimpaired Arm Improves the Motion of the Impaired Arm and the Sitting Balance in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2017; 25:873-882. [DOI: 10.1109/tnsre.2016.2635806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Unilateral Discomfort Increases the Use of Contralateral Side during Sit-to-Stand Transfer. Rehabil Res Pract 2017; 2017:4853840. [PMID: 28529804 PMCID: PMC5424184 DOI: 10.1155/2017/4853840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/09/2017] [Indexed: 11/18/2022] Open
Abstract
Individuals with unilateral impairment perform symmetrical movements asymmetrically. Restoring symmetry of movements is an important goal of rehabilitation. The aim of the study was to evaluate the effect of using discomfort-inducing devices on movement symmetry. Fifteen healthy individuals performed the sit-to-stand (STS) maneuver using devices inducing unilateral discomfort under the left sole and left thigh or right sole and right thigh and without them. 3D body kinematics, ground reaction forces, electrical activity of muscles, and the level of perceived discomfort were recorded. The center of mass (COM), center of pressure (COP), and trunk displacements as well as the magnitude and latency of muscle activity of lower limb muscles were calculated during STS and compared to quantify the movement asymmetry. Discomfort on the left and right side of the body (thigh and feet) induced statistically significant displacement of the trunk towards the opposite side. There was statistically significant asymmetry in the activity of the left and right Tibialis Anterior, Medial Gastrocnemius, and Biceps Femoris muscles when discomfort was induced underneath the left side of the body (thigh and feet). The technique was effective in causing asymmetry and promoted the use of the contralateral side. The outcome provides a foundation for future investigations of the role of discomfort-inducing devices in improving symmetry of the STS in individuals with unilateral impairment.
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Caderby T, Yiou E, Peyrot N, de Viviés X, Bonazzi B, Dalleau G. Effects of Changing Body Weight Distribution on Mediolateral Stability Control during Gait Initiation. Front Hum Neurosci 2017; 11:127. [PMID: 28396629 PMCID: PMC5366317 DOI: 10.3389/fnhum.2017.00127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 12/16/2022] Open
Abstract
During gait initiation, anticipatory postural adjustments (APA) precede the execution of the first step. It is generally acknowledged that these APA contribute to forward progression but also serve to stabilize the whole body in the mediolateral direction during step execution. Although previous studies have shown that changes in the distribution of body weight between both legs influence motor performance during gait initiation, it is not known whether and how such changes affect a person's postural stability during this task. The aim of this study was to investigate the effects of changing initial body weight distribution between legs on mediolateral postural stability during gait initiation. Changes in body weight distribution were induced under experimental conditions by modifying the frontal plane distribution of an external load located at the participants' waists. Fifteen healthy adults performed a gait initiation series at a similar speed under three conditions: with the overload evenly distributed over both legs; with the overload strictly distributed over the swing-limb side; and with the overload strictly distributed over the stance-leg side. Our results showed that the mediolateral location of center-of-mass (CoM) during the initial upright posture differed between the experimental conditions, indicating modifications in the initial distribution of body weight between the legs according to the load distribution. While the parameters related to the forward progression remained unchanged, the alterations in body weight distribution elicited adaptive changes in the amplitude of APA in the mediolateral direction (i.e., maximal mediolateral shift of the center of pressure (CoP)), without variation in their duration. Specifically, it was observed that the amplitude of APA was modulated in such a way that mediolateral dynamic stability at swing foot-contact, quantified by the margin of stability (i.e., the distance between the base of support boundary and the extrapolated CoM position), did not vary between the conditions. These findings suggest that APA seem to be scaled as a function of the initial body weight distribution between both legs so as to maintain optimal conditions of stability during gait initiation.
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Affiliation(s)
- Teddy Caderby
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Eric Yiou
- Laboratoire CIAMS, Université Paris Sud, Université Paris-SaclayOrsay, France; Laboratoire CIAMS, Université d'OrléansOrléans, France
| | - Nicolas Peyrot
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Xavier de Viviés
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Bruno Bonazzi
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Georges Dalleau
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
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Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review. Neurol Neurochir Pol 2016; 51:92-100. [PMID: 27884459 DOI: 10.1016/j.pjnns.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Tamošauskaitė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Petruševičienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Jung KS, Jung JH, In TS, Cho HY. Effects of Weight-shifting Exercise Combined with Transcutaneous Electrical Nerve Stimulation on Muscle Activity and Trunk Control in Patients with Stroke. Occup Ther Int 2016; 23:436-443. [PMID: 27753145 DOI: 10.1002/oti.1446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/09/2022] Open
Abstract
This study investigated the effects of weight-shifting exercise (WSE) combined with transcutaneous electrical nerve stimulation (TENS), applied to the erector spinae and external oblique (EO) muscles, on muscle activity and trunk control in patients with hemiparetic stroke. Sixty patients with stroke were recruited to this study and randomly distributed into three treatment groups: (1) WSE + TENS, (2) WSE + placebo TENS, and (3) control. All participants underwent 30 sessions of training (30 minutes five times per week for 6 weeks) and received 1 hour of conventional physical therapy five times per week for 6 weeks. Muscle activity, maximum reaching distance and trunk impairment scale scores were assessed in all patients before and after the training. After training, the WSE + TENS group showed significant increase in the EO activity, maximum reaching distance and trunk impairment scale scores compared with the WSE + placebo TENS and control groups. These findings suggest that WSE with TENS applied to the erector spinae and EO muscles increased the trunk muscle activity and improved trunk control. Therefore, WSE with TENS could be a beneficial intervention in clinical settings for individuals with hemiparetic stroke. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kyoung-Sim Jung
- Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon, Korea
| | - Tae-Sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon, Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Korea
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Jung KS, Cho HY, In TS. Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke. J Phys Ther Sci 2016; 28:940-4. [PMID: 27134389 PMCID: PMC4842470 DOI: 10.1589/jpts.28.940] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of trunk exercises performed on an unstable
surface on trunk muscle activation, postural control, and gait speed in stroke patients.
[Subjects] Twenty-four participants with stroke were recruited in this study and randomly
distributed into experimental (n = 12) and control groups (n = 12). [Methods] Subjects in
the experimental group participated in trunk exercises on the balance pad for 30 min, five
times a week for 4 weeks; those in the control group performed trunk exercises on a stable
surface for 30 min, five times a week for 4 weeks. Trunk muscle activation was measured by
using surface electromyography, and trunk control was evaluated with the Trunk Impairment
Scale (TIS). Gait speed was measured with the 10-Meter Walk Test. [Results] Activity of
the external and internal oblique muscles in the experimental group was significantly
higher than that in the control group. The TIS score of the experimental group showed
significantly greater improvement than did that of the control group. The 10-Meter Walk
Test (10MWT) score also significantly improved in the experimental group. [Conclusion]
Trunk exercises on an unstable surface improve trunk muscle activation, postural control,
and gait speed in patients with hemiparetic stroke.
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Affiliation(s)
- Kyoung-Sim Jung
- Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University: 191 Hambangmoe-ro, Yeonsu-gu, Incheon 406-799, Republic of Korea
| | - Tae-Sung In
- Department of Physical Therapy, Shin-Hwa Rehabilitation Hospital, Republic of Korea
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Stoller O, Rosemeyer H, Baur H, Schindelholz M, Hunt KJ, Radlinger L, Schuster-Amft C. Short-time weight-bearing capacity assessment for non-ambulatory patients with subacute stroke: reliability and discriminative power. BMC Res Notes 2015; 8:723. [PMID: 26611679 PMCID: PMC4661970 DOI: 10.1186/s13104-015-1722-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Weight-bearing capacity (WBC) on the hemiparetic leg is crucial for independent walking, and is thus an important outcome to monitor after a stroke. A specific and practical assessment in non-ambulatory patients is not available. This is of importance considering the increasing administration of high intensive gait training for the severely impaired stroke population. The aim was to develop a fast and easy-to-perform assessment for WBC on a foot pressure plate to be used in clinical routine. Methods WBC was assessed in the frontal plane in 30 non-ambulatory patients with subacute stroke and 10 healthy controls under 3 conditions: static, dynamic, and rhythmic. Force–time curves for the hemiparetic leg (patients with stroke) and the non-dominant leg (healthy controls) were normalised as a percentage of body weight (%BW), and the means analysed over 60, 30, and 15 s (static) and the mean of the peak values for 15, 10, 5, 4, and 3 repetition trials (dynamic, rhythmic). The data were tested for discriminative power and reliability. Dynamic and rhythmic tests could discriminate between patients with stroke and healthy controls over all periods (15, 10, 5, 4, and 3 repetitions) (p < 0.001), but not the static test (60 s, p = 0.639; 30 s, p = 0.708; 15 s, p = 0.685). Excellent relative intra-session [intra-class correlation (ICC) >0.829] and inter-session reliability (ICC = 0.740) were found for 3 repetitions in the dynamic test with acceptable absolute reliability [standard error of measurement (SEM) <5 %BW, minimal detectable difference (MDD) <12.4 %BW] and no within- or between-test differences (trial 1, p = 0.792; trial 2, p = 0.067; between trials, p = 0.102). Conclusions Three dynamic repetitions of loading the hemiparetic leg are sufficient to assess WBC in non-ambulatory patients with subacute stroke. This is an important finding regarding the implementation of a fast and easy-to-perform assessment for routine clinical usage in patients with limited standing ability.
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Affiliation(s)
- Oliver Stoller
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Heike Rosemeyer
- Physiotherapy Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Heiner Baur
- Division of Health, Applied Research and Development Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Matthias Schindelholz
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Kenneth J Hunt
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Lorenz Radlinger
- Division of Health, Applied Research and Development Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Corina Schuster-Amft
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
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Saghazadeh M, Tsunoda K, Soma Y, Okura T. Static Foot Posture and Mobility Associated With Postural Sway in Elderly Women Using a Three-dimensional Foot Scanner. J Am Podiatr Med Assoc 2015; 105:412-7. [PMID: 26429610 DOI: 10.7547/14-021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Maintaining balance is a complex phenomenon that is influenced by a range of sensorimotor factors. Foot posture and mobility may also influence balance and postural sway. Recently, three-dimensional foot scanners have been used to assess foot posture. This tool allows many individuals to be scanned quickly and easily and helps eliminate patients' radiation exposure. The objective of this study was to determine whether static foot posture and mobility are independently associated with postural sway in a large community sample of older women using objective measures of balance status and the recently launched technology of three-dimensional foot scanning. METHODS This cross-sectional study included 140 community-dwelling elderly women (mean ± SD age, 73.9 ± 5.1 years) recruited in Kasama City, Japan. The postural sway variables were total path length and area and were measured by force plate. We measured static foot posture, sitting and standing navicular height, and mobility using a three-dimensional foot scanner. Foot mobility was determined as the amount of vertical navicular excursion between the positions of the subtalar joint, from neutral in sitting position to relaxed bilateral standing. RESULTS After adjusting for potential cofounders, analysis of covariance revealed that sitting navicular height was associated with total path length (P = .038) and area (P = .031). Foot mobility was associated with total path length (P = .018). CONCLUSIONS These findings suggest that sitting navicular height and foot mobility are associated with postural sway in elderly women and might be an important factor in defining balance control in older adults.
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Affiliation(s)
- Mahshid Saghazadeh
- Department of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Kenji Tsunoda
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Yuki Soma
- Department of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tomohiro Okura
- Department of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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Saghazadeh M, Kitano N, Okura T. Gender differences of foot characteristics in older Japanese adults using a 3D foot scanner. J Foot Ankle Res 2015; 8:29. [PMID: 26180554 PMCID: PMC4502464 DOI: 10.1186/s13047-015-0087-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of gender differences in foot shape assists shoe manufactures with designing appropriate shoes for men and women. Although gender differences in foot shapes are relatively known among young men and women, less is known about how the older men and women's feet differ in shape. A recent development in foot shape assessment is the use of 3D foot scanners. To our knowledge this technology has yet to be used to examine gender differences in foot shape of Japanese older adults. METHODS This cross-sectional study included 151 older men (74.5 ± 5.6 years) and 140 older women (73.9 ± 5.1 years) recruited in Kasama City, Japan. Foot variables were measured in sitting and standing positions using Dream GP Incorporated's 3D foot scanner, Footstep PRO (Osaka, Japan). Scores were analyzed as both raw and normalized to truncated foot length using independent samples t-test and analysis of covariance, respectively. RESULTS In men, the measurement values for navicular height, first and fifth toe and instep heights, ball and heel width, ball girth, arch height index (just standing), arch rigidity index and instep girth were significantly greater than the women's, whereas the first toe angle, in both sitting and standing positions was significantly smaller. However, after normalizing, the differences in ball width, heel width, height of first and fifth toes in both sitting and standing and ball girth in sitting position were nonsignificant. According to Cohen's d, among all the foot variables, the following had large effect sizes in both sitting and standing positions: truncated foot length, instep, navicular height, foot length, ball girth, ball width, heel width and instep girth. CONCLUSION This study provides evidence of anthropometric foot variations between older men and women. These differences need to be considered when manufacturing shoes for older adults.
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Affiliation(s)
- Mahshid Saghazadeh
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574 Japan
| | - Naruki Kitano
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574 Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574 Japan
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Can static foot posture measurements predict regional plantar surface area? Foot (Edinb) 2014; 24:161-8. [PMID: 25168472 DOI: 10.1016/j.foot.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The intent of this study was to determine if the use of a single or combination of static foot posture measurements can be used to predict rearfoot, midfoot, and forefoot plantar surface area in individuals with pronated or normal foot types. METHODS Twelve foot measurements were collected on 52 individuals (mean age 25.8 years) with the change in midfoot width used to place subjects in a pronated or normal foot mobility group. Dynamic plantar contact area was collected during walking with a pressure sensor platform. The 12 measures were entered into a stepwise regression analysis to determine the optimal set of measures associated with regional plantar surface area. RESULTS A two variable model was found to describe the relationship between the foot measurements and forefoot plantar contact area (r(2)=0.79, p<0.0001). A four variable model was found to describe the relationship between the foot measurements and midfoot plantar contact area (r(2)=0.85, p<0.0001) in those individuals with a 1.26cm or greater change in midfoot width. CONCLUSIONS The results indicate that clinicians can use a combination of simple, reliable and time efficient foot measures to explain 79% and 85% of the plantar surface area in the forefoot and midfoot, respectively.
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Tsai YS, Yu YC, Huang PC, Cheng HYK. Seat surface inclination may affect postural stability during Boccia ball throwing in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3568-3573. [PMID: 25241116 DOI: 10.1016/j.ridd.2014.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 06/03/2023]
Abstract
The aim of the study was to examine how seat surface inclination affects Boccia ball throwing movement and postural stability among children with cerebral palsy (CP). Twelve children with bilateral spastic CP (3 with gross motor function classification system Level I, 5 with Level II, and 4 with Level III) participated in this study. All participants underwent pediatric reach tests and ball throwing performance analyses while seated on 15° anterior- or posterior-inclined, and horizontal surfaces. An electromagnetic motion analysis system was synchronized with a force plate to assess throwing motion and postural stability. The results of the pediatric reach test (p = 0.026), the amplitude of elbow movement (p = 0.036), peak vertical ground reaction force (PVGRF) (p < 0.001), and movement range of the center of pressure (COP) (p < 0.020) were significantly affected by seat inclination during throwing. Post hoc comparisons showed that anterior inclination allowed greater amplitude of elbow movement and PVGRF, and less COP movement range compared with the other inclines. Posterior inclination yielded less reaching distance and PVGRF, and greater COP movement range compared with the other inclines. The anterior-inclined seat yielded superior postural stability for throwing Boccia balls among children with bilateral spastic CP, whereas the posterior-inclined seat caused difficulty.
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Affiliation(s)
- Yung-Shen Tsai
- Graduate Institute of Sports Equipment Technology, University of Taipei, Taipei, Taiwan.
| | - Yi-Chen Yu
- New Taipei Municipal Bali Junior High School, New Taipei, Taiwan
| | - Po-Chang Huang
- Department of Physical Medicine and Rehabilitation, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Hsin-Yi Kathy Cheng
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Aruin AS, Rao N, Sharma A, Chaudhuri G. Compelled body weight shift approach in rehabilitation of individuals with chronic stroke. Top Stroke Rehabil 2013. [PMID: 23192720 DOI: 10.1310/tsr1906-556] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study was designed to evaluate the effectiveness of the compelled body weight shift (CBWS) therapy approach in the rehabilitation of individuals with chronic stroke. CBWS involves a forced shift of body weight toward a person's affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. METHOD Eighteen individuals with chronic, unilateral stroke (mean age 57.7 ± 11.9 years, with a range of 35-75 years; mean time since stroke 6.7 ± 3.9 years, with a range of 1.1-14.1 years) who showed asymmetrical stance were randomly divided into 2 groups: the experimental group received 6 weeks of physical therapy combined with CBWS therapy, and the control group received only physical therapy. Both groups underwent a battery of identical tests (Fugl-Meyer Assessment, Berg Balance Scale, weight bearing, and gait velocity) before the start of the rehabilitation intervention, following its completion, and 3 months after the end of therapy. RESULTS After the intervention, weight bearing on the affected side (measured with the Balance Master) increased in the experimental group to a larger degree compared to the control group (9.7% vs 6.4%). Similarly, gait velocity increased 10.5% in the experimental group compared to the control group. Improvements in weight bearing and gait velocity were maintained in the experimental group after the 3-month retention period. CONCLUSION The study outcome revealed that a 6-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke.
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Sato K, Heise GD. Influence of weight distribution asymmetry on the biomechanics of a barbell back squat. J Strength Cond Res 2012; 26:342-9. [PMID: 22228110 DOI: 10.1519/jsc.0b013e318220e0a3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to investigate the influence of weight distribution (WtD) asymmetry on the biomechanics of a barbell back squat. This study included 2 groups of trained individuals who were separated based on a WtD test (n = 14 in each group). They performed the barbell back squats with 2 resistance levels (60 and 75% of 1 repetition maximum) to measure vertical ground reaction force (GRF), tilting, and rotational angular bar displacements. A symmetry index (SI) score of the vertical GRF and the 2 bar displacements were examined to identify the group difference. Results showed that the unequal WtD group displayed a higher vertical GRF SI score (p < 0.05) and greater degrees of the tilting (p < 0.05) and rotational (p < 0.05) angular bar displacements. The 2 resistances did not influence the magnitude of the dependent variables, and no interactions were found. The unequal WtD captured at the WtD test carried over to the SI score during the back squat test. The unequal WtD was also a partial factor of displaying greater bar displacements. The lack of postural control to distribute body weight evenly should be treated properly to gain levelness before participating in high volume of resistance training, and coaches should be conscious of moving in a symmetrical fashion with minimal bar displacements in tilting and rotational manner.
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Affiliation(s)
- Kimitake Sato
- Kinesiology Program, Arizona State University, Tempe, Arizona, USA.
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35
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Verheyden G, van Duijnhoven HJR, Burnett M, Littlewood J, Kunkel D, Ashburn AM. Kinematic Analysis of Head, Trunk, and Pelvis Movement When People Early After Stroke Reach Sideways. Neurorehabil Neural Repair 2011; 25:656-63. [DOI: 10.1177/1545968311401628] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Sideways reaching with the unaffected arm while seated is a component of everyday activities and can be a challenging task early after stroke. Kinematic analysis of a lateral reach task may provide potential rehabilitation strategies. Objective. The authors examined the difference between people with stroke and healthy controls in the movement sequence of head, trunk, and pelvis, as well as the difference in angle at maximum reach and peak velocity for each body segment during reach and return. Methods. Twenty-four people within 12 weeks of a stroke and 20 healthy subjects performed a standardized lateral reach. Using CODAmotion, movement sequence was determined and angles and peak velocities were calculated. Results. When reaching, people with stroke moved their pelvis first, followed by the trunk and head, whereas healthy controls started with their head and then moved their trunk and pelvis. Patients achieved significantly smaller angles at maximum reach compared with healthy subjects for all body segments and lower peak velocities during the reach (for head, trunk, and pelvis) and the return (for head and trunk). Conclusions. Lateral reaching to the unaffected side early after stroke revealed a different pattern than normal and patients reached less far and moved at a slower speed. Specific training strategies to improve reaching are needed.
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36
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Yoon JY, Kim KM, Chang MY, Yoo WG, Oh JS, An DH. Foot Pressure and Trunk Muscle Activity during Reaching Tasks Performed by Seated Hemiplegia Patients. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji-Yeon Yoon
- Department of Physical Therapy, The Graduate School, Inje University
| | - Kyeong-Mi Kim
- Department of Occupational Therapy, College of Biomedical Science and Engineering, Inje University
| | - Moon-Young Chang
- Department of Occupational Therapy, College of Biomedical Science and Engineering, Inje University
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University
| | - Duk-Hyun An
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University
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Cherng RJ, Lin HC, Ju YH, Ho CS. Effect of seat surface inclination on postural stability and forward reaching efficiency in children with spastic cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:1420-1427. [PMID: 19647395 DOI: 10.1016/j.ridd.2009.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 07/05/2009] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to examine the effect of seat surface inclination on postural stability and forward reaching efficiency in 10 children with spastic cerebral palsy (CP) and 16 typically developing (TD) children. The children performed a static sitting and a forward reaching task while sitting on a height- and inclination-adjustable stool at flat, three anterior-inclined, and three posterior-inclined positions. Postural stability was expressed as normalized (with body weight) peak vertical ground reaction force, center of pressure displacement in the anterior/posterior directions (COP_AP), in the medial/lateral directions (COP_ML), and sway ratio (COP_AP/COP_ML). Reaching efficiency was expressed as reaction time and movement time of arm reaching forward to a target. The results showed that seat inclination affected children's postural stability and the effects were comparable for CP and TD children in all measures except for COP_ML. Children with CP presented much larger COP_ML than TD children at the posterior-inclined positions relative to the flat and the anterior-inclined positions. Seat inclination affected reaching efficiency for both groups of children equally. Efficiency was better at the anterior positions than the posterior positions. Anterior-inclined positions improved postural stability and reaching efficiency. Posterior positions posed greater postural challenge and the challenge was tougher for children with CP.
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Affiliation(s)
- Rong-Ju Cherng
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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McPoil TG, Vicenzino B, Cornwall MW, Collins N. Can foot anthropometric measurements predict dynamic plantar surface contact area? J Foot Ankle Res 2009; 2:28. [PMID: 19863799 PMCID: PMC2936827 DOI: 10.1186/1757-1146-2-28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/28/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. METHODS Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 +/- 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. RESULTS A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p < 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (R2 = 0.76, p < 0.0001). CONCLUSION The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.
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Affiliation(s)
- Thomas G McPoil
- The Laboratory for Foot & Ankle Research, Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, 86011, USA.
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Morishita M, Amimoto K, Matsuda T, Arai Y, Yamada R, Baba T. Analysis of dynamic sitting balance on the independence of gait in hemiparetic patients. Gait Posture 2009; 29:530-4. [PMID: 19138521 DOI: 10.1016/j.gaitpost.2008.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 08/27/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate the relationship between dynamic sitting balance and walking ability in stroke patients. Patients were evaluated using functional independence measure (FIM), and those with a locomotion score of 5 or below were categorized into the dependent walking and below group (dependent group) and those with a score of 6 or above were categorized into the independent walking group (independent group). They were asked to take a sitting position at the center of an unstable platform (seesaw). The experimenter passively tilted the unstable platform to the paretic side or non-paretic side by 10 degrees in the frontal plane. The unstable platform was released suddenly, with the experimenter supporting the platform with both hands, and the subjects were asked to control their posture so that their body axis came to the vertical position and the platform came to the horizontal position in the frontal plane. As a result, the body axis of left hemiplegic patients significantly tilted to the non-paretic side. On the other hand, in the dependent group in the right as well as left hemiplegic patients, the patients heads were tilted to the side from which tilting was started, though not significantly in both conditions. This study demonstrated that patients with poor walking function have a deviated verticality of the head and the body axis. We surmise that patients whose body axis tilts towards the non-paretic side during a dynamic balance maintenance task like this test would have lower walking independence.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Japanese School of Technology for Social Medicine, 2-22-32 Naka-cho, Koganei-city, Tokyo 184-8508, Japan.
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Effect of using truncated versus total foot length to calculate the arch height ratio. Foot (Edinb) 2008; 18:220-7. [PMID: 20307441 DOI: 10.1016/j.foot.2008.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 06/02/2008] [Accepted: 06/04/2008] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the arch height ratio in a large cohort of subjects as well as to assess the reliability and validity of the foot measurements utilized in the study. METHOD Eight hundred and fifty subjects, 393 women and 457 men, consented to participate in the study. The dorsal arch height, total foot length, and the truncated foot length were used to calculate two variations of the arch height ratio. In addition to determining within- and between-rater measurement reliability, radiographs were used to establish validity. RESULTS The truncated arch height ratio can be estimated using the total foot length, unless toe deformities are present in the individual being assessed. All foot measurements had high levels of intra- and inter-rater reliability and the validity of measuring the dorsal arch height while standing with equal weight on both feet was established. CONCLUSIONS This investigation provides normative values from a large cohort of healthy female and male subjects for two variations of the arch height ratio. The arch height ratio is a reliable and valid measurement that may prove useful to clinicians and researchers for the classification of foot posture.
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