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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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Sommer B, Haas M, Karrer S, Jörger M, Graf E, Huber M, Baumgartner D, Bansi J, Kool J, Bauer C. The Effect on Muscle Activity of Reaching Beyond Arm's Length on a Mobile Seat: A Pilot Study for Trunk Control Training for People After Stroke. Arch Rehabil Res Clin Transl 2023; 5:100289. [PMID: 38163026 PMCID: PMC10757194 DOI: 10.1016/j.arrct.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective This pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls. Design Observational pilot study. Setting This study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants. Participants A total of eleven people after stroke and fifteen healthy people (N=26) took part. Interventions Lateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat. Main Outcome Measure Muscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group. Results A seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat. Conclusions Mobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.
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Affiliation(s)
- Bettina Sommer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Michelle Haas
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Samuel Karrer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Matthias Jörger
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Eveline Graf
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Martin Huber
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Daniel Baumgartner
- School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jens Bansi
- Physiotherapy Department, Valens Rehabilitation Centre, Valens, Switzerland
- OST, University of Applied Sciences of Eastern Switzerland, St. Gallen, Switzerland
| | - Jan Kool
- Physiotherapy Department, Valens Rehabilitation Centre, Valens, Switzerland
| | - Christoph Bauer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
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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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Postural Difference between the Interventions Reflecting the Concept of Mirror Therapy in Healthy Subjects. Brain Sci 2021; 11:brainsci11121567. [PMID: 34942869 PMCID: PMC8699750 DOI: 10.3390/brainsci11121567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Mirror therapy is one of the promising interventions for the upper limb rehabilitation of stroke patients. Postural asymmetry during mirror therapy was pointed out as a possibility to influence stroke patients’ rehabilitation negatively. However, it is still difficult to find studies on the postural changes in mirror therapy concept interventions. This study compared three methods of postural differences as follows: traditional mirror therapy (mirror); displaying the real-time movement of the unaffected side on the screen above the affected side (screen); and playing a pre-recorded movement of the unaffected side on a tablet placed on a movable box where the affected hand is put inside (movable). (2) Methods: to observe a kinematic difference, we recruited 16 healthy volunteers to go through three different interventions (mirror, screen, movable). The motion capture system made observations on the postures before and during interventions, then compared and analyzed. (3) Results: while using the mirror, the sitting posture was observed to become asymmetric, and the following unique posture was observed where the target hand went further from the trunk while performing tasks. In addition, the shoulder of the target side came forward, and the difference between both elbow flexion angles was also observed. On the other hand, the screen or movable device did not cause a significant change in the sitting posture, and no additional postural differences were observed either. (4) Conclusions: mirror therapy showed a tendency to cause lateral flexion opposite the target hand, thus, creating additional postural change. However, developed methods controlled spine tilt, and enabled the keeping of the midline while sitting during the intervention.
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Ahmed U, Karimi H, Amir S, Ahmed A. Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial. J Int Med Res 2021; 49:3000605211059413. [PMID: 34812070 PMCID: PMC8647262 DOI: 10.1177/03000605211059413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke. METHODS In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go-cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups. RESULTS We observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months. CONCLUSIONS Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Trial registration: #IRCT20200127046275N1.
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Affiliation(s)
- Umair Ahmed
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Hossein Karimi
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan.,Istanbul Gelisim University, Istanbul, Turkey
| | - Syed Amir
- Istanbul Gelisim University, Istanbul, Turkey
| | - Ashfaq Ahmed
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan.,Allied Health Sciences, The University of Lahore, Lahore, Pakistan
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Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke. Hum Mov Sci 2021; 79:102834. [PMID: 34252758 DOI: 10.1016/j.humov.2021.102834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022]
Abstract
Assessment of upper limb function poststroke is critical for clinical management and determining the efficacy of interventions. We designed a unilateral upper limb task to simulate activities of daily living to examine how chronic stroke survivors manage reaching, grasping and handling skills simultaneously to perform the functional task using kinematic analysis. The aim of the study was to compare the motor strategies for performing a functional task between paretic and nonparetic arms. Sixteen chronic stroke survivors were instructed to control an ergonomic spoon to transfer liquid from a large bowl to a small bowl using paretic or nonparetic arm. Kinematic data were recorded using a Vicon motion capture system. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability. Results showed that movement duration, spoon path length, and trunk path length increased significantly when participants used paretic arm to perform the task. Participants tended to reduce shoulder and elbow excursions, and increase trunk excursions to perform the task with paretic arm and altered the relative timing of the task. Although participants used different motor strategies to perform the task with their paretic arms, we did not find the significant differences in trial-to trial variability of joint excursions between paretic and nonparetic arms. The results revealed differences in temporal and spatial aspects of motor strategies between paretic and nonparetic arms. Clinicians should explore the underlying causes of pathological movement patterns and facilitate preferred movement patterns of paretic arm.
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7
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Core Stability Exercises Yield Multiple Benefits for Patients with Chronic Stroke - Randomized Controlled Trial. Am J Phys Med Rehabil 2021; 101:314-323. [PMID: 34001840 DOI: 10.1097/phm.0000000000001794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of people with chronic stroke. DESIGN This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants an hour-long training session a day, thrice a week over a six-week duration, and followed-up after 12 months. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing and Activities-specific Balance Confidence scale were the outcome measures. RESULTS Compared to the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to post-training and from baseline to 12-month follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05). CONCLUSION Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.
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8
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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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9
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Karthikbabu S, Verheyden G. Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke. Top Stroke Rehabil 2020; 28:88-95. [PMID: 32574524 DOI: 10.1080/10749357.2020.1783896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Impaired trunk control and core muscle weakness affect balance capacity after stroke, but confirmatory literature is lacking. The objective was to examine the relationship between trunk control, core muscle strength and self-confidence on balance efficacy in community-dwelling chronic stroke survivors and to identify trunk performance measures for determining balance confidence. METHODS Patients with a median post-stroke duration of 12 (IQR 7-18) months and independent walking ability participated in this cross-sectional study. Trunk control, core muscle strength and balance confidence were measured using trunk impairment scale 2.0 (TIS 2.0), handheld dynamometer and activity-specific balance confidence scale, respectively. Correlation among TIS 2.0, core muscle strength and balance confidence were tested by Pearson's correlation coefficient. Stepwise multivariate linear regression analysis was conducted to examine the most important trunk performance variables determining balance confidence. RESULTS Of 177 study participants, the median (IQR) score for TIS 2.0 was 10 (7-12) out of 16 and for balance confidence 41 (27-61) out of 100. Trunk control was highly correlated to overall core muscles strength (r = 0.61-0.70, p <.001) and balance confidence (r = 0.66, p <.001). The major trunk determinants of balance confidence were TIS 2.0 total score (partial R2 = 0.433) and dynamic sitting balance, i.e. trunk lateral flexion (partial R2 = 0.376) in chronic stroke. CONCLUSION A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke, warranting further investigation of the effect of targeted trunk rehabilitation strategies on functional balance.
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Affiliation(s)
- Suruliraj Karthikbabu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospital , Bangalore, India
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven University of Leuven , Leuven, Belgium
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10
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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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11
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Balkaya MG, Trueman RC, Boltze J, Corbett D, Jolkkonen J. Behavioral outcome measures to improve experimental stroke research. Behav Brain Res 2018; 352:161-171. [DOI: 10.1016/j.bbr.2017.07.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 01/22/2023]
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12
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Peeters LHC, Kingma I, Faber GS, van Dieën JH, de Groot IJM. Trunk, head and pelvis interactions in healthy children when performing seated daily arm tasks. Exp Brain Res 2018; 236:2023-2036. [PMID: 29737378 PMCID: PMC6010485 DOI: 10.1007/s00221-018-5279-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/27/2018] [Indexed: 11/24/2022]
Abstract
Development of trunk and head supportive devices for children with neuromuscular disorders requires detailed information about pelvis, trunk and head movement in interaction with upper extremity movement, as these are crucial for daily activities when seated in a wheelchair. Twenty-five healthy subjects (6–20 years old) were included to obtain insight in the physiological interactions between these segments and to assess maturation effects. Subjects performed a maximum range of trunk and head movement tasks and several daily tasks, including forward and lateral reaching. Movements of the arms, head, pelvis, and sub-sections of the trunk were recorded with an optical motion capture system. The range of motion of each segment was calculated. Contributions of individual trunk segments to the range of trunk motion varied with movement direction and therefore with the task performed. Movement of pelvis and all trunk segments in the sagittal plane increased significantly with reaching height, distance and object weight when reaching forward and lateral. Trunk movement in reaching decreased with age. Head movement was opposite to trunk movement in the sagittal (> 50% of the subjects) and transverse planes (> 75% of the subjects) and was variable in the frontal plane in most tasks. Both trunk and head movement onsets were earlier compared to arm movement onset. These results provide insight in the role of the upper body in arm tasks in young subjects and can be used for the design of trunk and head supportive devices for children with neuromuscular disorders.
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Affiliation(s)
- L H C Peeters
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, 9101, 6500 HB, Nijmegen, The Netherlands.
| | - I Kingma
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - G S Faber
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - J H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - I J M de Groot
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, 9101, 6500 HB, Nijmegen, The Netherlands
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Trunk involvement in performing upper extremity activities while seated in neurological patients with a flaccid trunk - A review. Gait Posture 2018. [PMID: 29524797 DOI: 10.1016/j.gaitpost.2018.02.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trunk control is essential during seated activities. The trunk interacts with the upper extremities (UE) and head by being part of a kinematic chain and by providing a stable basis. When trunk control becomes impaired, it may have consequences for the execution of UE tasks. AIM To review trunk involvement in body movement and stability when performing seated activities and its relation with UE and head movements in neurological patients with a flaccid trunk, with a focus on childhood and development with age. METHODS AND PROCEDURES A search using PubMed was conducted and 32 out of 188 potentially eligible articles were included. OUTCOMES AND RESULTS Patients with a flaccid trunk (e.g. with spinal cord injury or cerebral palsy) tend to involve the trunk earlier while reaching than healthy persons. Different balance strategies are observed in different types of patients, like using the contralateral arm as counterweight, eliminating degrees of freedom, or reducing movement speed. CONCLUSIONS AND IMPLICATIONS The key role of the trunk in performing activities should be kept in mind when developing interventions to improve seated task performance in neurological patients with a flaccid trunk.
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Karthikbabu S, Chakrapani M, Ganesan S, Ellajosyula R, Solomon JM. Efficacy of Trunk Regimes on Balance, Mobility, Physical Function, and Community Reintegration in Chronic Stroke: A Parallel-Group Randomized Trial. J Stroke Cerebrovasc Dis 2018; 27:1003-1011. [PMID: 29361348 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/26/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke. SUBJECTS AND METHODS This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months. RESULTS Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05. CONCLUSION Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy.
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Affiliation(s)
- Suruliraj Karthikbabu
- Department of Physiotherapy, School of Allied Health Sciences (SOAHS), Manipal University, Manipal Hospital, Bengaluru, India.
| | - Mahabala Chakrapani
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Sailakshmi Ganesan
- Department of Physiotherapy, Spastics Society of Tamil Nadu, Chennai, Tamil Nadu, India
| | | | - John M Solomon
- Department of Physiotherapy, SOAHS, Manipal University, Manipal, India
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Wu YT, Choe YW, Peng C, Kim MK. The Immediate Effects of Posterior Pelvic Tilt with Taping on Pelvic Inclination, Gait Function and Balance in Chronic Stroke Patients*. ACTA ACUST UNITED AC 2017. [DOI: 10.13066/kspm.2017.12.3.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Yang-Ting Wu
- Dept. of Rehabilitation Sciences, Graduate School, Daegu University
| | - Yu-Won Choe
- Dept. of Rehabilitation Sciences, Graduate School, Daegu University
| | - Cheng Peng
- Dept. of Rehabilitation Sciences, Graduate School, Daegu University
| | - Myoung-Kwon Kim
- Dept. of Therapy, College of Rehabilitation Sciences, Daegu University
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16
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Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke. Am J Phys Med Rehabil 2017; 96:146-151. [DOI: 10.1097/phm.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitra S, Doherty N, Boulton H, Maylor EA. Age-related reversal of postural adjustment characteristics during motor imagery. Psychol Aging 2016; 31:958-969. [PMID: 27808526 PMCID: PMC5144809 DOI: 10.1037/pag0000120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Physical and imagined movements show similar behavioral constraints and neurophysiological activation patterns. An inhibition mechanism is thought to suppress overt movement during motor imagery, but it does not effectively suppress autonomic or postural adjustments. Inhibitory processes and postural stability both deteriorate with age. Thus, older people’s balance is potentially vulnerable to interference from postural adjustments induced by thoughts about past or future actions. Here, young and older adults stood upright and executed or imagined manual reaching movements. Reported arm movement time (MT) of all participants increased with target distance. Older participants reported longer MT than young participants when executing arm movements, but not when imagining them. Older adults’ anteroposterior (AP) and mediolateral (ML) postural sway was higher than young adults’ at baseline, but their AP sway fell below their baseline level during manual imagery. In contrast, young adults’ AP sway increased during imagery relative to their baseline. A similar tendency to reduce sway in the ML direction was also observed in older adults during imagery in a challenging stance. These results suggest that postural response during manual motor imagery reverses direction with age. Motor imagery and action planning are ubiquitous tasks, and older people are likely to spend more time engaged in them. The shift toward restricting body sway during these tasks is akin to a postural threat response, with the potential to interfere with balance during activities of daily living.
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18
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Karthikbabu S, Chakrapani M, Ganesan S, Ellajosyla R. Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ncn3.12092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Suruliraj Karthikbabu
- Department of Physiotherapy School of Allied Health Sciences Manipal University Manipal Hospital Bangalore India
| | - Mahabala Chakrapani
- Department of Medicine Kasturba Medical College Manipal University Mangalore India
| | - Sailakshmi Ganesan
- Department of Physiotherapy Kasturba Medical College Manipal University Mangalore India
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Boulton H, Mitra S. Incomplete inhibition of central postural commands during manual motor imagery. Brain Res 2015; 1624:321-329. [PMID: 26236027 DOI: 10.1016/j.brainres.2015.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/12/2015] [Accepted: 07/18/2015] [Indexed: 11/20/2022]
Abstract
Imagined movements exhibit many of the behavioral and neurophysiological characteristics of executed actions. As a result, they are considered simulations of physical actions with an inhibition mechanism that suppresses overt movement. This inhibition is incomplete, as it does not block autonomic preparation, and it also does not effectively suppress postural adjustments planned in support of imagined movements. It has been suggested that a central inhibition command may fail to suppress postural adjustments because it may not have access to afference-based elaborations of the postural response that occur downstream of central motor planning. Here, we measured changes in the postural response associated with imagining manual reaching movements under varying levels of imagined loading of the arm. We also manipulated stance stability, and found that postural sway reduced with increased (imagined) arm loading when imagining reaching movements from the less stable stance. As there were no afferent signals associated with the loading constraint, these results suggest that postural adjustments can leak during motor imagery because the postural component of the central motor plan is itself not inhibited effectively.
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Affiliation(s)
- Hayley Boulton
- Division of Psychology, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Suvobrata Mitra
- Division of Psychology, Nottingham Trent University, Nottingham NG1 4BU, UK.
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20
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Yang DJ, Park SK, Kim JH, Heo JW, Lee YS, Uhm YH. Effect of changes in postural alignment on foot pressure and walking ability of stroke patients. J Phys Ther Sci 2015; 27:2943-5. [PMID: 26504330 PMCID: PMC4616131 DOI: 10.1589/jpts.27.2943] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/18/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aims of this study were to determine (1) the significance of walking and
foot pressure in stroke patients, and (2) the association between changes in postural
alignment of stroke patients. [Subjects and Methods] Foot pressure and walking ability
based on postural alignment were measured in 50 stroke patients. Trunk imbalance, trunk
rotation, pelvic tilt, kyphosis, lordosis were measured using DIERS formetric4D (DIERS
International GmbH, Schlangenbad, Germany), which anlalyzes 3-dimensional spinal structure
in order to measure postural alignment. To determine foot pressure, the support rate of
weight and, average foot pressure were measured using DIERS pedoscan (DIERS International
GmbH, Schlangenbad, Germany) apparatus as a pressure platform. [Results] DIERS formetric
4D, DIERS pedoscan, and a 10 m walking test were utilized to measure foot pressure and
walking ability relative to changes in postural alignment in participating stroke
patients. [Conclusion] This study confirmed the significance of foot pressure and walking
ability as related postural alignment, indicating that postural alignment education and a
recovery therapy program for functional improvement of stroke patients should be provided
together.
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Affiliation(s)
- Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Jae Won Heo
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yong Seon Lee
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Sehan University Mokpo Rehabilitation Hospital, Republic of Korea
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21
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Fujino Y, Amimoto K, Fukata K, Ishihara S, Makita S, Takahashi H. Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized, controlled trial. Top Stroke Rehabil 2015; 23:43-9. [DOI: 10.1179/1945511915y.0000000010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Asai H, Tsuchiyama H, Hatakeyama T, Inaoka PT, Murata K. Relationship between the ability to perform the sit-to-stand movement and the maximum pelvic anteversion and retroversion angles in patients with stroke. J Phys Ther Sci 2015; 27:985-8. [PMID: 25995538 PMCID: PMC4434029 DOI: 10.1589/jpts.27.985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the relationship between the
ability to perform the sit-to-stand movement and the maximum pelvic anteversion and
retroversion angles of patients. [Subjects] Thirty-two stroke patients (66.7±7.6 years)
(>3 months post-stroke) who were able to sit unsupported and 50 age-matched healthy
subjects participated in this study. The stroke patients were classified into two groups
according to the sit-to-stand movement test: the group that was able to stand up (the
stand-able group) (18 persons) and the group that was unable to stand up (the stand-unable
group) (14 persons). [Methods] Pelvic anteversion and retroversion maximum angles were
measured by a manual goniometer attached to an inclinometer. [Results] The maximum pelvic
anteversion angles were −1.6 ± 5.0°, 1.2 ± 2.8°, and −12.4 ± 6.1° in the control group,
the stand-able stroke group, and the stand-unable stroke group, respectively. A
significant main effect of group was found. An angle discriminating between the two stroke
groups was found: the maximum anteversion angles in the stand-able group were distributed
above −5°. [Conclusion] The maximum pelvic anteversion angle was significantly smaller in
the stand-unable group than in the stand-able and control groups.
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Affiliation(s)
- Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, Kanazawa University, Japan
| | | | | | - Pleiades Tiharu Inaoka
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, Kanazawa University, Japan
| | - Kanichirou Murata
- Department of Rehabilitation, Fukui College of Health Sciences, Japan
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Lemos T, Souza NS, Horsczaruk CHR, Nogueira-Campos AA, de Oliveira LAS, Vargas CD, Rodrigues EC. Motor imagery modulation of body sway is task-dependent and relies on imagery ability. Front Hum Neurosci 2014; 8:290. [PMID: 24847241 PMCID: PMC4021121 DOI: 10.3389/fnhum.2014.00290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/18/2014] [Indexed: 01/06/2023] Open
Abstract
In this study we investigate to what extent the effects of motor imagery on postural sway are constrained by movement features and the subject's imagery ability. Twenty-three subjects were asked to imagine three movements using the kinesthetic modality: rising on tiptoes, whole-body forward reaching, and whole-body lateral reaching. After each task, subjects reported the level of imagery vividness and were subsequently grouped into a HIGH group (scores ≥3, “moderately intense” imagery) or a LOW group (scores ≤2, “mildly intense” imagery). An eyes closed trial was used as a control task. Center of gravity (COG) coordinates were collected, along with surface EMG of the deltoid (medial and anterior portion) and lateral gastrocnemius muscles. COG variability was quantified as the amount of fluctuations in position and velocity in the forward-backward and lateral directions. Changes in COG variability during motor imagery were observed only for the HIGH group. COG variability in the forward-backward direction was increased during the rising on tiptoes imagery, compared with the control task (p = 0.01) and the lateral reaching imagery (p = 0.02). Conversely, COG variability in the lateral direction was higher in rising on tiptoes and lateral reaching imagery than during the control task (p < 0.01); in addition, COG variability was higher during the lateral reaching imagery than in the forward reaching imagery (p = 0.02). EMG analysis revealed no effects of group (p > 0.08) or task (p > 0.46) for any of the tested muscles. In summary, motor imagery influences body sway dynamics in a task-dependent manner, and relies on the subject' imagery ability.
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Affiliation(s)
- Thiago Lemos
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil
| | - Nélio S Souza
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brasil
| | - Carlos H R Horsczaruk
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brasil
| | - Anaelli A Nogueira-Campos
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil ; Departamento de Fisiologia, Universidade Federal de Juiz de Fora Minas Gerais, Brasil
| | - Laura A S de Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brasil
| | - Claudia D Vargas
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil
| | - Erika C Rodrigues
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brasil ; Instituto D'Or de Pesquisa e Ensino Rio de Janeiro, Brasil
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Kitago T, Liang J, Huang VS, Hayes S, Simon P, Tenteromano L, Lazar RM, Marshall RS, Mazzoni P, Lennihan L, Krakauer JW. Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair 2012; 27:99-109. [PMID: 22798152 DOI: 10.1177/1545968312452631] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) has proven effective in increasing functional use of the affected arm in patients with chronic stroke. The mechanism of CIMT is not well understood. OBJECTIVE To demonstrate, in a proof-of-concept study, the feasibility of using kinematic measures in conjunction with clinical outcome measures to better understand the mechanism of recovery in chronic stroke patients with mild to moderate motor impairments who undergo CIMT. METHODS A total of 10 patients with chronic stroke were enrolled in a modified CIMT protocol over 2 weeks. Treatment response was assessed with the Action Research Arm Test (ARAT), the Upper-Extremity Fugl-Meyer score (FM-UE), and kinematic analysis of visually guided arm and wrist movements. All assessments were performed twice before the therapeutic intervention and once afterward. RESULTS There was a clinically meaningful improvement in ARAT from the second pre-CIMT session to the post-CIMT session compared with the change between the 2 pre-CIMT sessions. In contrast, FM-UE and kinematic measures showed no meaningful improvements. CONCLUSIONS Functional improvement in the affected arm after CIMT in patients with chronic stroke appears to be mediated through compensatory strategies rather than a decrease in impairment or return to more normal motor control. We suggest that future large-scale studies of new interventions for neurorehabilitation track performance using kinematic analyses as well as clinical scales.
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Affiliation(s)
- Tomoko Kitago
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Wu CY, Chen YA, Chen HC, Lin KC, Yeh IL. Pilot Trial of Distributed Constraint-Induced Therapy With Trunk Restraint to Improve Poststroke Reach to Grasp and Trunk Kinematics. Neurorehabil Neural Repair 2011; 26:247-55. [DOI: 10.1177/1545968311415862] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Constraint-induced therapy (CIT) is effective in improving upper extremity motor function, but evidence is lacking about effectiveness grasp and trunk control. Objective. This study investigated whether distributed CIT combined with trunk restraint (dCIT + TR) benefited movement kinematics of grasping and the trunk, as well as motor ability of the upper extremity, more than dCIT alone. Methods. A total of 45 stroke participants received 2 hours of dCIT + TR, dCIT, or the dose-matched control intervention for 3 weeks. Movement kinematics, motor ability, and daily function were the outcome measures. Movement kinematics included grasping, joint range, and trunk movement at various phases of reach-to-grasp tasks. Motor ability and daily function of all participants were evaluated using the Fugl-Meyer Assessment and the Motor Activity Log. Results. Four to 5 participants in each group were not included for kinematic analysis because of their inability to grasp a can. The dCIT + TR group showed better preplanned grasping movement and less trunk motion at the early phase of the reach-to-grasp movements than the dCIT or control groups. Compared with the controls, the dCIT + TR participants showed better motor ability in the overall and distal arm scores of the Fugl-Meyer Assessment. The dCIT + TR and dCIT participants demonstrated significantly greater functional use of the affected arm. Conclusions. Administering dCIT + TR produced additional benefits by improving grasping control and reversing the compensatory trunk movement at the early phase of a reach-to-grasp movement. The use of experimental tasks beyond and within arm’s length might improve our understanding of optimal upper extremity rehabilitation.
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