Lateral Trunk Displacement and Stability During Sit-to-Stand Transfer in Relation to Foot Placement in Patients With Hemiparesis

Abstract

Background. In hemiparetic individuals, sit-to-stand (STS) transfer is characterized by asymmetric weight-bearing and altered trunk kinematics that can be improved by positioning the affected foot behind the nonaffected one. Objective. To examine the influence of frontal trunk kinematics on medio-lateral displacements of the center of pressure (CP) during STS performed with the feet placed in 2 different positions, as well as relationships between these parameters, medio-lateral stability, and clinical scores of the participants. Methods. Eighteen patients with chronic stroke and 15 control individuals were evaluated during sit-to-stand transfers either in spontaneous foot position or with their affected or dominant foot placed behind, respectively. Medio-lateral CP, pelvis, and shoulder displacement were analyzed using 3D kinematic and kinetic data recordings of the whole task. Motor and sensory impairment, spasticity, muscle strength, and equilibrium were evaluated by standard scales. The possible time during which a participant could prevent a fall (minimal time-to-contact) was used as a stability index. Results. Spontaneously, the deviation of the CP of stroke participants paralleled the tilt of the trunk toward the nonaffected side, as early as the first third of the task. With the affected foot placed behind, trunk position did not differ from those of control participants who executed the transfer spontaneously. Hemiparetic participants were less stable than control participants. Placement of the feet had no significant effect on the stability of either group. Stability was strongly associated with better motor scores on the Chedoke-McMaster Stroke Assessment. Conclusions. In hemiparetic individuals, improving STS symmetry by positioning the affected foot behind the nonaffected one did not decrease medio-lateral stability, which was associated with the level of stroke-related motor impairments.

Keywords

Foot position Postural stability Trunk kinematics Stroke Fall.

References

Nyberg L. , Gustafson Y. Patient falls in stroke rehabilitation: a challenge to rehabilitation strategies . Stroke. 1995;26:838-842.

Hyndman D. , Ashburn A. , Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil . 2002;83:165-170.

Yoshida K. , Iwakura H. , Inoue F. Motion analysis in the movements of standing up from and sitting down on a chair. A comparison of normal and hemiparetic subjects and the differences of sex and age among the normals. Scand J Rehabil Med. 1983;15:133-140.

Engardt M. , Olsson E. Body weight-bearing while rising and sitting down in patients with stroke . Scand J Rehabil Med. 1992;24:67-74.

Hesse S. , Schauer M. , Malezic M. , et al. Quantitative analysis of rising from a chair in healthy and hemiparetic subjects. Scand J Rehabil Med. 1994;26:161-166.

Malouin F. , Richards CL , Doyon J. , et al. Training mobility tasks after stroke with combined mental and physical practice: a feasibility study. Neurorehabil Neural Repair. 2004;18:66-75.

Chou SW , Wong AM , Leong CP , et al. Postural control during sit-to stand and gait in stroke patients . Am J Phys Med Rehabil. 2003;82:42-47.

Roy G. , Nadeau S. , Gravel D. , et al. The effect of foot position and chair height on the asymmetry of vertical forces during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis. Clin Biomech. 2006;21:585-593.

Tyson SF Measurement error in functional balance and mobility tests for people with stroke. Neurorehabil Neural Repair. 2007;21: 46-50.

10.

Cheng PT , Liaw MY , Wong MK , et al. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil. 1998;79:1043-1046.

11.

Brunt D. , Greenberg B. , Wankadia S. , et al. The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia. Arch Phys Med Rehabil . 2002;83:924-929.

12.

Roy G. , Nadeau S. , Gravel D. , et al. Side difference in the hip and knee joint moments during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis. Clin Biomech. 2007;22:795-804.

13.

Lecours J. , Nadeau S. , Gravel D. , et al. Interactions between foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat off during rising from a chair in healthy and hemiparetic persons. J Rehabil Med. 2008;40: 200-207.

14.

Gowland C. , Stratford P. , Ward M. , et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993;24:58-63.

15.

Berg KO , Wood-Dauphinee SL , Williams JI The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27-36.

16.

Levin MF , Hui-Chan C. Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity? J Neurol. 1993; 240:63-71.

17.

Desjardins P. , Nadeau S. , Gravel D. , et al. A chair with a platform setup to measure the forces under each thigh when sitting, rising from a chair and sitting down. Thirteenth Biennial Conference, Canadian Society for Biomechanics; August 4-7, 2004; Halifax; 2004:4.

18.

Sardain P. , Bessonnet G. Forces acting on a biped robot. Center of pressure-zero moment point. IEEE Trans Syst Man Cybernet. 2004;34:630-637.

19.

Patton JL , Lee WA , Pai YC Relative stability improves with experience in a dynamic standing task. Exp Brain Res. 2000;135:117-126.

20.

Slobounov SM , Slobounova ES , Newell KM Virtual time-to-collision and human postural control. J Mot Behav. 1997;29:263-281.

21.

Lee MY , Wong MK , Tang FT , et al. New quantitative and qualitative measures on functional mobility prediction for stroke patients. J Med Eng Technol. 1998;22:14-24.

22.

De Bujanda E. , Nadeau S. , Bourbonnais D. Pelvic and shoulder movements in the frontal plane during treadmill walking in adults with stroke. J Stroke Cerebrovasc Dis. 2004;13:58-69.

23.

McIlroy WE , Maki BE Age-related changes in compensatory stepping in response to unpredictable perturbations. J Gerontol. 1996;51:M289-M296.

24.

Pavol MJ , Pai YC Deficient limb support is a major contributor to age differences in falling . J Biomech. 2007;40:1318-1325.

25.

Hirschfeld H. , Thorsteinsdottir M. , Olsson E. Coordinated ground forces exerted by buttocks and feet are adequately programmed for weight transfer during sit-to-stand. J Neurophysiol. 1999;82: 3021-3029.

26.

Yang F. , Anderson FC , Pai YC Predicted threshold against backward balance loss in gait. J Biomech. 2007;40:804-811.