Relationship between trunk stability during voluntary limb and trunk movements and clinical measurements of patients with chronic stroke

[Purpose] The purposes of this study were to investigate differences between patients with chronic stroke and age matched healthy controls in trunk stability, by assessing the kinematics of the center of mass and moving body segments during voluntary limb and trunk movement, and the relationship between trunk stability and clinical measurements. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Each subject performed flexion of the hip and shoulder of the non-paretic or matched side as fast as possible, as well as trunk flexion and extension at a self-selected speed. A Qualisys motion system was employed to track the kinematics of the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the center of mass during all limb and trunk movements, and larger velocity of center of mass during hip flexion movement. Healthy subjects showed greater movement velocity during shoulder flexion, trunk flexion and extension. Patients’ clinical measurements only correlated with movement characteristics during voluntary trunk motions. [Conclusion] Trunk stability in patients with chronic stroke was compromised during voluntary trunk as well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk deficits measured using clinical measurements. Rehabilitation of patients with chronic stroke should include programs to improve trunk stability.Key words: Stroke, Trunk stability, Kinematics     

Kinematic upper extremity performance in people with near or fully recovered sensorimotor function after stroke

Background: Clinical scales for upper extremity motor function may not capture improvement among higher functioning people with stroke. Objective: To describe upper extremity kinematics in people with stroke who score within the upper 10% of the Fugl-Meyer Assessment (FMA-UE) and explore the ceiling effects of the FMA-UE. Design: A cross-sectional study design was used. Participants: People with stroke were included from the Stroke Arm Longitudinal Study at University of Gothenburg together with 30 healthy controls. The first analysis included participants who achieved FMA-UE score > 60 within the first year of stroke (assessed at 3 days, 2 weeks, 4 weeks, 3 months, or 12 months post stroke). The second analysis included participants with submaximal FMA-UE (60–65 points, n = 24) or maximal FMA-UE score (66 points, n = 21) at 3 months post stroke. Measurements: The kinematic analysis of a standardized drinking task included movement time, velocity and strategy, joint angles of the elbow, and shoulder and trunk displacement. Results: The high FMA-UE stroke group showed deficits in seven of eight kinematic variables. The submaximal FMA-UE stroke group was slower, had lower tangential and angular peak velocity, and used more trunk displacement than the controls. In addition, the maximal FMA-UE stroke group showed larger trunk displacement and arm abduction during drinking and lower peak angular velocity of the elbow. Conclusions: Participants with near or fully recovered sensorimotor function after stroke still show deficits in movement kinematics; however, the FMA-UE may not be able to detect these impairments.     

Relationship between lower limb coordination and walking speed after stroke: an observational study

BackgroundAlthough lower limb muscle strength is associated with walking performance in people after stroke, even when there is good strength, walking speed may remain slower than normal, perhaps due to incoordination.ObjectiveThe aim of this study was to examine the relationship between walking speed and lower limb coordination in people with good strength after stroke.MethodsAn observational study was conducted with 30 people with stroke and 30 age-matched controls. Inclusion criteria for stroke were good lower limb strength (i.e., ≥Grade 4) and walking speed at >0.6 m/s without aids in bare feet (with recruitment stratified so that walking speed was evenly represented across the range). Walking performance was measured as speed during the 10-m Walk Test and distance during the 6-min Walk Test. Coordination was measured using the Lower Extremity Motor Coordination Test and reported in taps/s.ResultsStroke survivors walked at 1.00 (SD 0.26) m/s during the10-m Walk Test (64% of normal), walked 349 (SD 94) m during the 6-min Walk Test (68% of normal), and performed the Lower Extremity Motor Coordination Test at 1.20 (SD 0.34) taps/s with the affected side (64% of normal). Lower Extremity Motor Coordination Test scores for the affected side were statistically significantly correlated with walking performance in the 10-m Walk Test (r = 0.42, p = 0.02) and the 6-min Walk Test (r = 0.50, p = 0.01).ConclusionCoordination was related to walking performance, suggesting that loss of coordination may contribute to slow walking in this group of stroke survivors with good strength.Trial registration: ANZCTR12614000856617 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366827).     

The prevalence,distribution, and functional importance of lower limb somatosensory impairments in chronic stroke survivors: a cross sectional observational study

Purpose: To investigate the prevalence and distribution of lower limb somatosensory impairments in community dwelling chronic stroke survivors and examine the association between somatosensory impairments and walking, balance, and falls.

Methods: Using a cross sectional observational design, measures of somatosensation (Erasmus MC modifications to the (revised) Nottingham Sensory Assessment), walking ability (10?m walk test, Walking Impact Scale, Timed “Get up and go”), balance (Functional Reach Test and Centre of Force velocity), and falls (reported incidence and Falls Efficacy Scale-International), were obtained.

Results: Complete somatosensory data was obtained for 163 ambulatory chronic stroke survivors with a mean (SD) age 67(12) years and mean (SD) time since stroke 29 (46) months. Overall, 56% (n?=?92/163) were impaired in the most affected lower limb in one or more sensory modality; 18% (n?=?30/163) had impairment of exteroceptive sensation (light touch, pressure, and pin-prick), 55% (n?=?90/163) had impairment of sharp-blunt discrimination, and 19% (n?=?31/163) proprioceptive impairment. Distal regions of toes and foot were more frequently impaired than proximal regions (shin and thigh). Distal proprioception was significantly correlated with falls incidence (r?=?0.25; p?<?0.01), and centre of force velocity (r?=?0.22, p?<?0.01). The Walking Impact Scale was the only variable that significantly contributed to a predictive model of falls accounting for 15–20% of the variance.

Conclusion: Lower limb somatosensory impairments are present in the majority of chronic stroke survivors and differ widely across modalities. Deficits of foot and ankle proprioception are most strongly associated with, but not predictive, of reported falls. The relative contribution of lower limb somatosensory impairments to mobility in chronic stroke survivors appears limited. Further investigation, particularly with regard to community mobility and falls, is warranted.

• Implications for Rehabilitation

• Somatosensory impairments in the lower limb were present in approximately half of this cohort of chronic stroke survivors.

• Tactile discrimination is commonly impaired; clinicians should include an assessment of discriminative ability.

• Deficits of foot and ankle proprioception are most strongly associated with reported falls.

• Understanding post-stroke lower limb somatosensory impairments may help inform therapeutic strategies that aim to maximise long-term participation, minimise disability, and reduce falls.

     

Clinical utility of the modified trunk impairment scale for stroke survivors

Objective: The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.

Design: Cross-sectional.

Setting: Inpatient rehabilitation center.

Participants: Fifty-five subjects with stroke and 29 healthy adults.

Methods: Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.

Results: The mTIS results differed significantly between stroke survivors and healthy adults (p?r?=?0.82), Timed Up and Go test (r?=?–0.70), 5-m Walk Test (r?=?0.73), Functional Ambulation Category (r?=?0.54), Fugl-Meyer Assessment (r?=?0.37–0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r?=?0.55–0.63), and Modified Barthel Index score (r?=?0.56) results (p?10.5 points, while the area under the curve had a moderate accuracy of 73%.

Conclusion: The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors.

• Implications for Rehabilitation

• The modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors.

• The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.

     

Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury

Background: The aim of this study was to assess the performance of an original powered foot clearance creator (PFCC) mechanism worn in conjunction with an isocentric reciprocal gait orthosis (IRGO) and evaluate its effect on trunk compensatory movements and spatiotemporal parameters in nine healthy subjects.

Method: A PFCC motorized mechanism was designed that incorporated twin sole plates, the movements of which enabled increased toe to floor clearance during swing phase. A prototype was constructed in combination with an IRGO, and hence was re-named as an IRGO-PFCC orthosis. The effects of IRGO-PFCC usage on the spatiotemporal parameters and trunk compensatory movements during walking were then analyzed under two conditions, firstly with the PFCC ‘active’ i.e., with the motorized device functioning, and secondly inactive, where floor clearance was standard.

Results: Ambulating with IRGO-PFCC orthosis resulted in reduction in the spatiotemporal parameters of gait (speed of walking, cadence and stride length) in nine healthy subjects. Walking with IRGO-PFCC orthosis led to significant differences in lateral (p?=?.007) and vertical (p?=?.008) trunk compensatory movements. In other words, through using IRGO-PFCC orthosis, the lateral and vertical trunk compensatory movements decreased by 51.32% and 42.7%, respectively.

Conclusion: An adapted PFCC mechanism, with a relatively small motor and power supply could effectively increase toe to floor clearance during swing phase and thereby decrease trunk compensatory motions and potentially improve energy consumption.

• Implications for rehabilitations

• ?The High rejection rates of reciprocal gait orthoses are related to the increasing in energy expenditure and burden loads on the upper limb joints during walking following trunk compensatory movements.?An original powered foot clearance creator mechanism was designed and constructed to assisting floor clearance capability and reduce trunk compensatory movements in subjects with spinal cord injury during swing phase of gait.?This original powered foot clearance creator mechanism by using moveable soleplates and motorized actuation could decrease the trunk compensatory motions during the ambulation of nine healthy subjects.?More experiments are needed to investigate this mechanism on trunk compensatory movements of SCI subjects.

     

Kinematic analysis of the hip and trunk during bilateral stance on firm,foam, and multiaxial support surfaces

OBJECTIVE: To differentiate hip and trunk motion during double-leg stance. DESIGN: Trunk and hip angular position variances were measured on different support surfaces with and without vision. BACKGROUND: Postural control results from motion about the hips and trunk during bilateral stance. While the hip joint has been studied extensively, information concerning relative amounts of hip and trunk motions during postural control is limited. METHODS: Trunk flexion/extension, trunk lateral flexion, right and left hip flexion/extension and abduction/adduction angular position variances were assessed in 14 normal subjects using an electromagnetic tracking system during bilateral stance on firm, foam, and multiaxial support surfaces with and without vision. RESULTS: Significantly greater amounts of motion occurred at all joints for the multiaxial-eyes closed condition compared to all other surface-vision conditions. No significant differences were found between any other surface-vision conditions. Within the multiaxial-eyes closed condition, right and left hip flexion/extension and abduction/adduction magnitudes were significantly greater than those of trunk flexion and lateral flexion, and left hip flexion/extension motion was significantly greater than that of the right hip. CONCLUSIONS: Postural control mechanisms involve similar amounts of motion at the hips and trunk, except for conditions under which a rigid base of support becomes unstable and vision is eliminated. RELEVANCE: These results suggest that the trunk and hips should be considered separately during kinematic analysis of postural control. This information may be useful in providing a more sensitive assessment of postural control to identify balance-related pathologies associated with stroke, concussion, and somatosensory deficits.     

Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients

[Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke.Key words: Stroke, Electromyography, Trunk reposition sense     

Bone-density changes after stroke

It has been many years since bone loss and fracture risk were first recognized as serious complications of stroke. Hip fracture is associated with a substantial increase in morbidity and mortality for stroke survivors, and therefore, assessing and maintaining skeletal health after stroke should be an important clinical goal. Recent long-term, prospective studies have illustrated a highly nonuniform pattern of bone changes after stroke. In general, there is significant bone loss on the paretic side, which is greatest in those patients with the most severe functional deficits. In some patients, bone loss in the paretic arm during the first year after stroke is the equivalent of >20 yrs of bone loss in healthy individuals of comparable age. Bone density in the nonparetic upper limb can actually increase after stroke, consistent with an increase in habitual use of the nonparetic hand. Bone density in the paretic lower limb can decrease by >10% in <1 yr, with smaller decreases being typical for the nonparetic lower limb. Despite the recent increase in the number of prospective, longitudinal studies, important questions about bone changes after stroke remain unanswered. Longer-term studies quantifying bone loss for periods of >12 mos poststroke are needed to determine how long excess bone loss continues after stroke. Studies with more subjects and with more varied disability levels are needed to better understand the relationships between functional deficits and bone loss. New metrics are needed to quantify the intensity and duration of physical activity in the upper and lower limbs that are consistent with previous research on the role of mechanical stimuli in bone adaptation. Finally, an assessment of skeletal health and the factors that affect bone quantity and quality should be a standard component in the clinical management of all survivors of stroke.     

Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke

ObjectiveTo explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve.MethodsAn exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals’ comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination).ResultsThe characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve.ConclusionsThe level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.     

Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement

BackgroundFemoroacetabular impingement is a pathomechanical hip condition leading to pain and impaired physical function. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric muscle contractions. However, no studies to-date have looked at trunk kinematics or muscle activation during dynamic movements such as stair climbing in this patient population. The purpose of this study was to compare biomechanical outcomes (trunk and lower limb kinematics as well as lower limb kinetics and muscle activation) during stair climbing in those with and without symptomatic femoroacetabular impingement.MethodsTrunk, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and muscle activity of nine lower limb muscles were collected during stair climbing for 20 people with clinical and radiographic femoroacetabular impingement and compared to 20 age- and sex-matched pain-free individuals.FindingsThose with femoroacetabular impingement ascended the stairs slower (effect size = 0.82), had significantly increased peak trunk forward flexion angles (effect size = 0.99) and external hip flexion moments (effect size = 0.94) and had decreased peak external knee flexion moments (effect size = 0.90) compared to the control group.InterpretationFindings from this study indicate that while those with and without femoroacetabular impingement exhibit many biomechanical similarities when ascending stairs, differences in trunk forward flexion and joint kinetics indicate some important differences. Further longitudinal research is required to elucidate the cause of these differences as well as the clinical relevance.     

Ankle-foot orthoses in stroke: Effects on functional balance,weight-bearing asymmetry and the contribution of each lower limb to balance control

Background

Ankle-foot orthoses are often provided to improve walking in stroke patients, although the evidence of effects on walking and balance control is still inconsistent. This could be caused by a lack of insight into the influence of orthoses on the underlying impairments. These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing. This study examined the effects of ankle-foot orthoses on functional balance, static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs.

Methods

Twenty stroke subjects (time since stroke 5–127 months) completed the study. Subjects were assessed with and without ankle-foot orthosis. Functional balance was assessed using the Berg Balance Scale, Timed Up & Go test, Timed Balance Test, 10-m walking test and Functional Ambulation Categories. Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform.

Findings

No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control, but significant differences in favour of ankle-foot orthosis use were found for most functional tests.

Interpretation

Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb, functional tests were performed significantly better with orthoses. Apparently, improvements at functional level cannot be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control. This finding suggests that ankle-foot orthoses influence compensatory mechanisms.     

Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke

BACKGROUND: Walking following stroke involves compensatory strategies by the unaffected leg to cope with the deficits in the hemiparetic leg. Recently, training paradigms based on the principles of task-oriented repetitive exercise have provided a valuable insight regarding the influence of restraining compensatory movements to improve motor performances. We investigated changes in the walking movements of each lower extremity after weighting the unaffected leg. METHODS: Ten individuals early after a stroke (range: 3-7 months) who were able to walk 10 m with no aids, participated to this study. Subjects were instructed to walk on a treadmill with an external mass attached around the non affected ankle during a single session. The short-term effects on gait performance were quantified by a 3D-gait analysis system before, immediately after and 20 min after the walking technique. FINDINGS: A one factor repeated measures model revealed that stroke participants significantly improved in walking speed (P<0.001), step length (P<0.01) and cadence (P<0.01). Weight-bearing on the paretic leg increased (P<0.01) along with kinematic modifications including greater hip and knee excursion. When the mass was removed, these adaptations were maintained 20 min later. INTERPRETATION: Preliminary findings suggest that even brief gait training using a treadmill with a restrictive weight placed on the distal extremity of the non-hemiplegic lower limb can improve laboratory measures of gait ability in a sample of stroke subjects. Future studies must evaluate the effect of this technique in longer-term locomotor retraining.     

Compensatory trunk movements in patients with hip osteoarthritis: accuracy and reproducibility of a body-fixed sensor-based assessment

This study examined the accuracy and reproducibility of a body-fixed sensor-based assessment for quantifying frontal plane angular movements of the (upper) thorax and pelvis of patients with hip osteoarthritis at different walking speeds. To evaluate accuracy, the angular movements of sensors attached to the thorax and pelvis of three patients were compared with results based on an optical motion analysis system. Accuracy was high, with small and consistent mean differences (<1.0 degree) and corresponding standard deviations (<1.3 degrees) between optical motion analysis system and body-fixed sensor data. To evaluate reproducibility, angular trunk movements were assessed twice in 15 patients. Reproducibility was high (intraclass correlation coefficients ranged from 0.86 to 0.97), and the values of the mean differences between the test and retest were small, with the 95% confidence interval containing zero. This body-fixed sensor-based assessment is an accurate and reproducible method for quantifying frontal plane compensatory trunk movements during gait of patients with hip osteoarthritis at different walking speeds.     

Trunk kinetic effort during step ascent and descent in patients with transtibial amputation using angular momentum separation

BackgroundPatients with transtibial amputation adopt trunk movement compensations that alter effort and increase the risk of developing low back pain. However, the effort required to achieve high-demand tasks, such as step ascent and descent, remains unknown.MethodsKinematics were collected during bilateral step ascent and descent tasks from two groups: 1) seven patients with unilateral transtibial amputation and 2) seven healthy control subjects. Trunk kinetic effort was quantified using translational and rotational segmental moments (time rate of change of segmental angular momentum). Peak moments during the loading period were compared across limbs and across groups.FindingsDuring step ascent, patients with transtibial amputation generated larger sagittal trunk translational moments when leading with the amputated limb compared to the intact limb (P = 0.01). The amputation group also generated larger trunk rotational moments in the frontal and transverse planes when leading with either limb compared to the healthy group (P = 0.01, P < 0.01, respectively). During step descent, the amputation group generated larger trunk translational and rotational moments in all three planes when leading with the intact limb compared to the healthy group (P < 0.017).InterpretationThis investigation identifies how differing trunk movement compensations, identified using the separation of angular momentum, require higher kinetic effort during stepping tasks in patients with transtibial amputation compared to healthy individuals. Compensations that produce identified increased and asymmetric trunk segmental moments, may increase the risk of the development of low back pain in patients with amputation.     

Variability of neck and trunk movement during single- and dual-task gait in people with chronic neck pain

BackgroundPrevious findings reported that people with chronic neck pain walk with reduced range trunk rotation, especially when walking in more challenging conditions. Quantification of the quality of neck and trunk movement during gait could provide further insight into biomechanical changes that occur in people with neck pain. This study uniquely compared the variability of trunk and neck rotation during single-task and dual-task gait in people with chronic neck pain and asymptomatic individuals.MethodsAn observational case-control study was conducted on 20 asymptomatic individuals and 24 people with chronic neck pain of idiopathic or traumatic origin. Participants performed rectilinear walking whilst keeping the head in a neutral position (single-task) and whilst rotating the head at a natural speed (dual-task). Trunk and head rotation angles were averaged across gait cycles for the task trials. The data were normalised in time, and the average variability of angular distribution along the normalised cycle was extracted. The Tampa Scale for Kinesiophobia was used to assess fear of movement.FindingsDuring single-task gait, there were no group differences for the variability of trunk (p = 0.862) or neck (p = 0.427) rotation. For dual-task gait, there was no difference between groups for the variability of neck rotation (p = 0.636), however, the participants with neck pain displayed reduced variability of trunk rotation (p = 0.021). The neck pain group also walked at a significantly slower speed during dual-task gait (p = 0.043) compared to asymptomatic individuals and the speed of their gait was associated with the extent of fear of movement.InterpretationThe strategy observed in participants with chronic neck pain likely reflects adaptive behaviour when faced with more challenging conditions for postural control.     

Trunk movement compensation identified by inertial measurement units is associated with deficits in physical performance,muscle strength and functional capacity in people with hip osteoarthritis

BackgroundTrunk movement compensation characterized as ipsilateral trunk lean and posterior rotation with respect to pelvis during stance phase of walking is common in people with hip osteoarthritis and a biomarker of deficits in physical function in older adults. However, the relationship between trunk movement compensation on deficits in physical performance, muscle strength and functional capacity is unknown.MethodsA cross-sectional study design was used. Two inertial measurement units were used to assess trunk movement compensation during the six-minute-walk-test. Knee extension, knee flexion and hip abduction strength were measured using hand-held dynamometer. Multivariate regression models, controlling for self-reported hip pain, were used to regress trunk movement compensation onto six-minute-walk-test and muscle strength measures. Pairwise t-tests were used to evaluate the difference trunk movement compensation has on functional capacity by comparing the first and last minute of the six-minute-walk-test.FindingsThirty-five participants (63.3 ± 7.4 years, 57% male, 28.6 ± 4.5 kg/m²) were enrolled. Greater trunk movement compensation was related to poorer six-minute-walk-test (p = 0.03; r = −0.46). Greater hip abduction weakness was related to increased trunk movement compensation in both the sagittal (p = 0.05; r = −0.44) and frontal (p = 0.04; r = −0.38) planes. Participants demonstrated greater frontal plane trunk movement compensation during the last minute compared to the first minute of the six-minute-walk-test (p < 0.01).InterpretationTrunk movement compensation, identified by inertial measure units, is a clinically relevant measure and has a moderate-to-strong relationship on deficits in physical performance, muscle strength and functional capacity. Inertial measurement units can be used as a practical means of measuring movement quality in the clinical setting.     

Falls in community-dwelling stroke survivors: an accumulated impairments model

Falling has been identified as a major complication in persons who have had a stroke. The purpose of this study was to investigate the effect of accumulated impairments on the risk of falling in community-dwelling stroke survivors. METHODS: Community-dwelling stroke survivors were identified from the Kansas City Stroke Study, a large cohort study of stroke survivors. We evaluated the subjects within 14 days of stroke onset. Impairments were determined at baseline and were defined as motor = Fugl-Meyer lower-limb score > 28, sensory = sensory score on National Institutes of Health (NIH) Stroke Scale > 0, and visual = hemianopsia score on NIH Stroke Scale > 0. Accumulated impairments were characterized as motor only (n = 101), motor + sensory (n = 88), and motor + sensory + visual (n = 47). The reference group did not possess motor, sensory, or visual impairments. We completed follow-ups at 1 month, 3 months, and 6 months poststroke to determine the fall status of the subjects. RESULTS: Two hundred eighty subjects were included. Falls were reported by 142 subjects (51%) between 1 month and 6 months poststroke. Univariate analysis revealed that the risk of falling for subjects with motor impairment only was odds ratio (OR) = 2.2 (95% confidence interval [CI] 1.05 to 4.70), motor + sensory impairments OR = 3.1 (95% CI 1.46 to 6.79), and motor + sensory + visual impairments OR = 2.4 (95% CI 1.05 to 5.83) as compared to the group with no motor, sensory, and visual impairments. In multiple logistic regression, the risk of falling increased with motor impairment only and motor + sensory impairments. However, the motor + sensory + visual impairments group had a lower risk of falling. Secondary analysis revealed a significant difference in mobility scores (Orpington Prognostic Scale-balance) among individuals with motor impairment only, motor + sensory impairments, motor + sensory + visual impairments, and the reference group. This lower risk of falling in stroke survivors with motor + sensory + visual impairments may be explained by more involved strokes, more impaired balance, and subsequently less mobility, therefore, lowering their risk of falling. In conclusion, community-dwelling persons who have had a stroke are at a higher risk of falling. However, the risk of falling is not linearly related to the number of impairments. Individuals with motor, sensory, and visual impairments are less mobile and less likely to fall than those individuals with motor deficits only or motor and sensory deficits.     

Comparison of Hip and Low Back Loads between Normal Gait,Axillary Crutch Ambulation and Walking with a Hands-free Crutch in a Healthy Population

BackgroundInstead of using axillary crutches, using a hands-free crutch (HFC) has been associated with higher functional outcome scores. However, hip and back pain have been reported as side effects.Purpose/HypothesisThe purpose of this study was to compare range of motion and joint reaction forces at the hip and low back between HFC walking, normal walking, and standard crutch walking. It was hypothesized that hip joint reaction forces and low back joint reaction forces would be higher with HFC walking compared with normal walking and axillary crutch walking.Study DesignControlled Laboratory StudyMethodsUsing 3D motion analysis and force plates, kinematics and ground reaction forces were measured in 12 healthy subjects during gait, crutch ambulation and HFC walking. Gait speed, hip and trunk range of motion, and hip and low back reaction forces, were compared using repeated-measures ANOVA.ResultsGait speed during HFC ambulation was reduced 33% compared to crutch ambulation (P<0.001) and 44% compared to normal gait (p<0.001). Hip range of motion was reduced during both crutch conditions compared to gait (p<0.001). Trunk range of motion was greatest during HFC walking compared to both gait and crutch ambulation (p<0.001). Peak hip joint reaction force during HFC walking was 11% lower than during gait (p=0.026) and 30% lower than during crutch walking (p<0.001). Peak low back reaction force during HFC walking was 18% higher than during gait (p=0.032) but not different than during crutch walking.ConclusionHip joint reaction forces during HFC walking did not exceed those during gait or axillary crutch ambulation. However, a reduction in hip motion using the HFC was associated with increases in trunk motion and low-back loading. These could be a cause for reports of low-back pain accompanying HFC usage.Level of EvidenceLevel 3