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Mallo-López A, Cuesta-Gómez A, Fernández-Pardo TE, Aguilera-Rubio Á, Molina-Rueda F. Influence of Impaired Upper Extremity Motor Function on Static Balance in People with Chronic Stroke. SENSORS (BASEL, SWITZERLAND) 2024; 24:4311. [PMID: 39001091 PMCID: PMC11244378 DOI: 10.3390/s24134311] [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: 06/04/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Stroke is a leading cause of disability, especially due to an increased fall risk and postural instability. The objective of this study was to analyze the impact of motor impairment in the hemiparetic UE on static balance in standing, in subject with chronic stroke. METHODS Seventy adults with chronic stroke, capable of independent standing and walking, participated in this cross-sectional study. The exclusion criteria included vestibular, cerebellar, or posterior cord lesions. The participants were classified based on their UE impairment using the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). A posturographic evaluation (mCTSIB) was performed in the standing position to analyze the center of pressure (COP) displacement in the mediolateral (ML) and anteroposterior (AP) axes and its mean speed with eyes open (OE) and closed (EC) on stable and unstable surfaces. RESULTS A strong and significant correlation (r = -0.53; p < 0.001) was observed between the mediolateral (ML) center of pressure (COP) oscillation and the FMA-UE, which was particularly strong with eyes closed [r(EO) = 0.5; r(EC) = 0.54]. The results of the multiple linear regression analysis indicated that the ML oscillation is influenced significantly by the FMA-Motor, and specifically by the sections on UE, wrist, coordination/speed, and sensation. CONCLUSIONS The hemiparetic UE motor capacity is strongly related to the ML COP oscillation during standing in individuals with chronic stroke, with a lower motor capacity associated with a greater instability. Understanding these relationships underpins the interventions to improve balance and reduce falls in people who have had a stroke.
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Affiliation(s)
- Ana Mallo-López
- International Doctorate School, Rey Juan Carlos University, 28933 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Alicia Cuesta-Gómez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Teresa E. Fernández-Pardo
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
- Physiotherapy Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Ángela Aguilera-Rubio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
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Inui Y, Mizuta N, Hayashida K, Nishi Y, Yamaguchi Y, Morioka S. Characteristics of uneven surface walking in stroke patients: Modification in biomechanical parameters and muscle activity. Gait Posture 2023; 103:203-209. [PMID: 37245334 DOI: 10.1016/j.gaitpost.2023.05.022] [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: 01/29/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Stroke patients have difficulty walking in outdoor environments, including uneven surfaces, reducing their opportunities for social participation. Changes in stroke patients' gait while walking on even surfaces have been reported; however, gait alterations on uneven surfaces remain unclear. RESEARCH QUESTION To what extent do biomechanical parameters and muscle activity during even and uneven surface walking differ between stroke patients and healthy people? METHODS Twenty stroke patients and 20 age-matched healthy people walked on a 6 m even and uneven surfaces. Data on gait speed, root mean square (RMS) of trunk acceleration as a measure of gait stability, maximum joint angle, average muscle activity, and muscle activity time were quantified using accelerometers attached to the trunk, video camera images, and electromyography of lower extremities. A two-factor mixed-model analysis of variance was used to test the effects of group, surface, and group × surface interactions. RESULTS Gait speed decreased (p < 0.001) on the uneven surface in stroke patients and healthy people. RMS showed an interaction (p < 0.001), and the post-hoc test revealed an increase in stroke patients in the mediolateral direction during the swing phase on the uneven surface. The hip extension angle during the stance phase showed an interaction (p = 0.023), and the post-hoc test revealed a decrease in stroke patients on the uneven surface. The soleus muscle activity time showed an interaction during the swing phase (p = 0.041), and the post-hoc test revealed an increase in stroke patients compared to healthy people only on the uneven surface. SIGNIFICANCE While walking on an uneven surface, stroke patients showed decreased gait stability, decreased hip extension angle during stance phase, and increased ankle plantar flexor activity time during swing phase. These changes may result from impaired motor control and compensatory strategies used by stroke patients on uneven surfaces.
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Affiliation(s)
- Yasuhiro Inui
- Department of Neurorehabilitation, Kio University, Nara, Japan; Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan.
| | - Naomichi Mizuta
- Department of Physical Therapy, School of Health Science, Nihon Fukushi University, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Kazuki Hayashida
- Department of Rehabilitation, Wakayama Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Yuki Nishi
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Yuki Yamaguchi
- Department of Neurorehabilitation, Kio University, Nara, Japan; Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
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Onursal Kılınç Ö, De Ridder R, Kılınç M, Van Bladel A. Trunk and lower extremity biomechanics during sit-to-stand after stroke: A systematic review. Ann Phys Rehabil Med 2022; 66:101676. [PMID: 35597449 DOI: 10.1016/j.rehab.2022.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 03/24/2022] [Accepted: 04/18/2022] [Indexed: 12/09/2022]
Abstract
OBJECTIVES This systematic review aimed to pool available evidence of differences in trunk and lower extremity biomechanics during the different phases of a sit-to-stand (STS) task between persons with stroke and to healthy controls. METHODS Four electronic databases (Medline, Web of Science, EMBASE, and Cochrane Library) were systematically searched up to, and including, December 2021. Studies were included if they investigated kinematic, kinetic and/or electromyographic outcome measures of adults with stroke during STS and compared results with healthy controls. Data from eligible studies were categorized according to STS subphases if reported (Phase I: Movement onset to seat-off; Seat-off; Phase II: Seat-off to movement termination; Whole task [if no subtasks reported]). The Newcastle-Ottawa Scale was used to assess risk of bias. RESULTS Twenty-one studies were included in this systematic review. Methodological quality ranged from 13% to 75%; mean score was 55%. The findings of this systematic review suggest that after stroke, people rise to stand (phase I) with increased lateral trunk flexion and displacement of the center of pressure (COP) towards the non-paretic side, decreased anterior pelvic tilt, decreased hip flexion and altered timing of lower limb muscle activation. In addition, during phase II, lateral pelvic translation and weight distribution asymmetry was increased, knee extension velocity was decreased and delayed, stabilization was decreased and COP velocity was increased compared with healthy subjects. CONCLUSIONS This systematic review clearly showed changes in kinematics, kinetics and muscle recruitment after stroke, with differences between the different phases of STS. Therapeutic interventions should focus on subphases of this functional task to optimize performance in daily living.
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Affiliation(s)
- Özge Onursal Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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Sekiguchi Y, Honda K, Izumi SI. Effect of Walking Adaptability on an Uneven Surface by a Stepping Pattern on Walking Activity After Stroke. Front Hum Neurosci 2022; 15:762223. [PMID: 35058764 PMCID: PMC8764227 DOI: 10.3389/fnhum.2021.762223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Real-world walking activity is important for poststroke patients because it leads to their participation in the community and physical activity. Walking activity may be related to adaptability to different surface conditions of the ground. The purpose of this study was to clarify whether walking adaptability on an uneven surface by step is related to daily walking activity in patients after stroke. We involved 14 patients who had hemiparesis after stroke (age: 59.4 ± 8.9 years; post-onset duration: 70.7 ± 53.5 months) and 12 healthy controls (age: 59.5 ± 14.2 years). The poststroke patients were categorized as least limited community ambulators or unlimited ambulators. For the uneven surface, the study used an artificial grass surface (7 m long, 2-cm leaf length). The subjects repeated even surface walking and the uneven surface walking trials at least two times at a comfortable speed. We collected spatiotemporal and kinematic gait parameters on both the even and uneven surfaces using a three-dimensional motion analysis system. After we measured gait, the subjects wore an accelerometer around the waist for at least 4 days. We measured the number of steps per day using the accelerometer to evaluate walking activity. Differences in gait parameters between the even and uneven surfaces were calculated to determine how the subjects adapted to an uneven surface while walking. We examined the association between the difference in parameter measurements between the two surface properties and walking activity (number of steps per day). Walking activity significantly and positively correlated with the difference in paretic step length under the conditions of different surface properties in the poststroke patients (r = 0.65, p = 0.012) and step width in the healthy controls (r = 0.68, p = 0.015). The strategy of increasing the paretic step length, but not step width, on an uneven surface may lead to a larger base of support, which maintains stability during gait on an uneven surface in poststroke patients, resulting in an increased walking activity. Therefore, in poststroke patients, an increase in paretic step length during gait on an uneven surface might be more essential for improving walking activity.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- *Correspondence: Yusuke Sekiguchi,
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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Implications of Optimal Feedback Control Theory for Sport Coaching and Motor Learning: A Systematic Review. Motor Control 2021; 26:144-167. [PMID: 34920414 DOI: 10.1123/mc.2021-0041] [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: 03/16/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
Best practice in skill acquisition has been informed by motor control theories. The main aim of this study is to screen existing literature on a relatively novel theory, Optimal Feedback Control Theory (OFCT), and to assess how OFCT concepts can be applied in sports and motor learning research. Based on 51 included studies with on average a high methodological quality, we found that different types of training seem to appeal to different control processes within OFCT. The minimum intervention principle (founded in OFCT) was used in many of the reviewed studies, and further investigation might lead to further improvements in sport skill acquisition. However, considering the homogenous nature of the tasks included in the reviewed studies, these ideas and their generalizability should be tested in future studies.
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Kuramatsu Y, Suzukamo Y, Izumi SI. Two types of sensorimotor strategies for whole-body movement in individuals with stroke: a pilot study. Physiother Theory Pract 2021; 38:2580-2591. [PMID: 34402735 DOI: 10.1080/09593985.2021.1962461] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE This study compared the sensory-motor interactions and strategies for whole-body movement in individuals with stroke who had damaged motor system area or sensory system area in the brain. METHODS Participants with hemiparesis were asked to perform sit-to-stand movements while their vision was restricted, which can affect completion of the task. The participants were divided into two groups. The first group had no history of lesions in the sensory system area but did have a history of lesions in the motor system area (no damaged sensory-system: NDS). The second group had a history of lesions in the sensory system area of the brain (damaged sensory-system: DS). Center-of-pressure (COP) trajectories were measured to evaluate balance control in participants with and without vision, and numbers of sub-movements (i.e. numbers of segmented movements which reflect the degree of use of the feedback loops) were measured to evaluate feedforward and feedback control. Movement times were also measured. RESULTS When vision was restricted, NDS participants showed increased variability in mediolateral COP trajectories during movement and utilized mainly feedforward control. In contrast, DS participants showed reduced variability in mediolateral COP trajectories during movement and utilized additional feedback control. CONCLUSIONS These results demonstrate two types of strategies for whole-body movements in individuals with stroke. These differences may be attributed to whether the individual can compensate for vision with somatic senses and whether appropriate processing of somatosensory information has been lost. Individuals with hemiparesis created dexterous and flexible strategies to execute tasks successfully, depending on the characteristics of their sensorimotor disorders.
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Affiliation(s)
- Yuko Kuramatsu
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Aoba-ku, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Aoba-ku, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Aoba-ku, Japan.,Graduate School of Biomedical Engineering, Tohoku University, Aoba-ku, Japan
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