Effect of Trunk Support on Upper Extremity Function in People With Chronic Stroke and People Who Are Healthy

BACKGROUND

Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption in neurorehabilitation has not been validated in clinical trials.

OBJECTIVE

The study objectives were to investigate the effect of providing external trunk support on trunk control and UE function and to examine the relationship between trunk control and UE function in people with chronic stroke and people who were healthy.

DESIGN

A cross-sectional study was conducted.

METHODS

Twenty-five people with chronic stroke and 34 people who were healthy and matched for age and sex were recruited. Trunk control was assessed with the Trunk Impairment Scale (TIS), and UE impairment and UE function were assessed with the UE subsection of the Fugl-Meyer Assessment (FMA-UE) and the Streamlined Wolf Motor Function Test (SWMFT), respectively. The TIS and SWMFT were evaluated, with and without external trunk support; the FMA-UE was evaluated without trunk support.

RESULTS

With trunk support, people with stroke showed improvement from 18 to 20 points on the TIS, a reduction in SWMFT performance times from 37.20 seconds to 35.37 seconds for the affected UE, and improvement from 3.3 points to 3.4 points on the SWMFT Functional Ability Scale for the function of the affected UE. With trunk support, the SWMFT performance time for people who were healthy was reduced from 1.61 seconds to 1.48 seconds for the dominant UE and from 1.71 seconds to 1.59 seconds for the nondominant UE. A significant moderate correlation was found between the TIS and the FMA-UE (r=.53) for people with stroke.

LIMITATIONS

The limitations included a nonmasked assessor and a standardized height of the external trunk support.

CONCLUSIONS

External trunk support improved trunk control in people with chronic stroke and had a statistically significant effect on UE function in both people with chronic stroke and people who were healthy. The findings suggest an association between trunk control and the UE when external trunk support was provided and support the hypothesis that lower trunk and lumbar stabilization provided by external support enables an improvement in the ability to use the UE for functional activities.

The effect of standing and sitting postures on breathing in brass players

Purpose

The object of this study was to examine the effect of posture on breathing in brass players. Breathing when standing was compared with sitting erect on a flat, downward or upward sloping seat, or on a reclining seat.

Methods

Spirometry was used to measure aspects of lung function. Muscle activity and respiratory movements during different playing tasks were recorded using electromyography and inductive plethysmography.

Results

Only sitting in a reclining position produced statistically significantly lower values for VC, FVC, FEV1, PEF than standing. When players were asked to produce a note of maximum duration, only a downward sloping seat caused a significant change (an 11% reduction) compared to standing. When seated, the abdominal component of respiratory movement was significantly higher during these long notes than when standing, though maximum activity in abdominal wall muscles was significantly reduced (by 32–44%). On a downward sloping seat, muscle activity was significantly higher (9%) than on a flat seat. Tongued and untongued sforzando notes recruited significantly less abdominal muscle activity (33–67%) when sitting than when standing. When playing a trumpet study, abdominal muscle activity was significantly reduced on a downward sloping seat (by 32%) and on a flat seat (by 40%) in comparison to standing. Muscle activity in the two sitting positions were not significantly different.

Conclusion

Though brass players are often told to “sit as if standing”, abdominal muscle activity is always significantly reduced when sitting on a flat or downward sloping seat, however when greater respiratory effort is required, activity on downward sloping seats may rise closer to that of standing.

Appropriate seating for medical patients: an audit

OBJECTIVE

To determine the number and types of chairs available for patient use; to establish minimum criteria of appropriate chairs; and to assess the suitability of available chairs to seat patients admitted to medical wards.

METHODS

Audit of chairs available in medical wards in a tertiary referral public hospital was conducted. All chairs relevant to patient use were photographed and counted. An expert panel determined minimum criteria of appropriate seating for older patients from functional, occupational health and safety, ergonomic, infection control and usability viewpoints. The number of chairs meeting the minimum criteria level was recorded and was expressed as a percentage of the number of required chairs (hospitalised patients able to be sat out of bed).

RESULTS

A total of 270 chairs of 36 different types were identified. The majority of chairs, 231 (85%), did not meet the minimum criteria. Thirty-nine chairs met the minimum criteria for patients to sit in with 113 (66%) patients unable to sit out of bed.

CONCLUSION

This study identified that there were insufficient appropriate chairs available for patients to sit out of bed in this facility. This has potential implications for functional ability of the patients, particularly for the older person.