Effects of upper extremity training in a standing position on trunk alignment in stroke patients

Effect of a rigid ankle foot orthosis and an ankle foot orthosis with an oil damper plantar flexion resistance on pelvic and thoracic movements of patients with stroke during gait

BACKGROUND

Impairments of trunk movements in gait of stroke are often reported. Ankle foot orthosis (AFO) is commonly used to improve gait of stroke; however, the effect of different types of AFOs on the pelvic and thoracic movements during gait in stroke has not been clarified.

METHODS

Thirty-four patients with stroke were randomly allocated to undergo 2 weeks of gait training by physiotherapists while wearing a rigid AFO (RAFO) with a fixed ankle or an AFO with an oil damper (AFO-OD) that provides plantarflexion resistance and free dorsiflexion. A motion capture system was used for measurements of shod gait without AFO at baseline and with and without AFO after gait training. Two-way repeated ANOVA, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for the data after the gait training to know the effect of different kinds of AFOs.

RESULTS

Twenty-nine patients completed the study (AFO-OD group: 14, RAFO group: 15). Interactions were found in pelvic rotation angle, change of shank-to-vertical angle (SVA) in the stance, and paretic to non-paretic step length, which increased in AFO-OD group with AFOs (p < 0.05), while the SVA decreased in RAFO group with AFOs (p < 0.05). The main effects were found in pelvic rotation at the contralateral foot off, and thoracic tilt at foot off when an AFO was worn. The change of SVA in stance was positively correlated with the pelvic rotation in the AFO-OD group (r = 0.558). At initial contact, pelvic rotation was positively correlated with thoracic rotation in both groups.

CONCLUSIONS

The findings in 29 patients with stroke showed that pelvic and thoracic movements especially the rotation were affected by the type of AFOs. Pelvic rotation and lower limb kinematics exhibited significant improvements with AFO-OD, reflecting more desirable gait performance. On the other hand, the increase in thoracic in-phase rotation might expose the effect of insufficient trunk control and dissociation movement. Trial registration UMIN000038694, Registered 21 November 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000044048 .

Effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with chronic stroke: A randomized pilot study

BACKGROUND

Patients with stroke have hypomobility in the facet joint of affected side. Lumbar joint mobilization could be used to maintain function and mobility of the joints.

OBJECTIVE

This study aimed to investigate the effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with stroke.

METHODS

Thirty patients with stroke were randomly assigned to two groups. Lumbar joint mobilization was provided for 15 min, 5 times a week for 6 weeks to patients who were allocated into the experimental group. Patients who were allocated into the control group received a sham intervention. Trunk function (trunk impairment scale), postural balance (weight distribution, Berg balance scale, and timed up and go test), and walking (10 m walk test, functional gait assessment, step length, and stride length) were evaluated before and after the experiment for all the patients.

RESULTS

Lumbar joint mobilization significantly improved trunk function, postural balance, and gait compared with pre-test values in the experimental group (P< 0.05). Significant differences were seen in trunk function, postural balance, and walking between the two groups (P< 0.05).

CONCLUSION

Lumbar joint mobilization might be an effective intervention for trunk function, postural balance, and walking in patients with stroke.

Immediate Effects of Arm Reaching Training in Standing on Postural Control Differ between Right and Left Stroke Individuals

BACKGROUND

Arm reaching training in standing for several weeks affects the postural control of individuals recovering from cerebrovascular accident (CVA). Whether these effects differ with the side of the brain lesion are unknown.

OBJECTIVES

To examine the immediate effects of a training session of arm reaching movements on the balance and trunk motion of individuals who suffered a right or left CVA.

MATERIALS AND METHODS

Thirty-six adults divided into four groups (i.e., right CVA, left CVA, right control, and left control) performed 120 reaches in a standing position toward one of three target heights. Before and after the reaching trials, participants stood as quiet as possible on two force plates and had their postural sway, trunk motion, and body weight distribution assessed.

RESULTS

CVA groups showed greater postural sway regardless of the brain lesion's side compared to the control groups. After the session of reaching movements, the left stroke group reduced the postural sway and trunk displacements. Larger ranges of weight-bearing asymmetry were more frequent after the training session, mainly for the right stroke group.

CONCLUSIONS

A single session training of reaching movements affects mostly the postural control of left stroke survivors. More training sessions may be needed for individuals after right stroke to show balance improvements. The current findings support the hemispheric specialization for postural control and suggest that the training involving arm movements in standing can benefit the motor rehabilitation of stroke individuals.