Association of trunk control with mobility performance and accelerometry-based gait characteristics in hemiparetic patients with subacute stroke
Introduction
Stroke and cerebrovascular disease are leading causes of morbidity, mortality, and disability, and are the most common cause of the need for long-term care in Japan [1]. As well as upper- and lower-extremity impairments, trunk motor impairment also arises from stroke and follows the time course of the recovery [2], [3]. Trunk control plays an important role in movement control and postural balance during functional activities. Previous studies have demonstrated that trunk control after stroke is closely associated with functional balance and activities of daily living [4], [5], [6], and is an important predictor of functional recovery [7], [8], [9]. These results suggest the importance of intensive rehabilitation treatment targeting trunk control after stroke. Several randomized controlled studies have investigated the effects of trunk exercises in people with stroke, as highlighted in a recent systematic review [10]. Saeys and colleagues [11] showed that the effects of trunk exercises transferred to improved standing balance and mobility in addition to improved trunk performance.
Impaired mobility is one of the most common symptoms of stroke, and falls often occur during walking in the community setting after hospital discharge [12]. Therefore, regaining independent mobility with a safe and stable gait pattern is one of the main goals of stroke rehabilitation. Although the relation between trunk performance and mobility has been studied in non-acute and chronic stroke patients [4], it has not been studied in the early phase of stroke. In addition, it has recently been reported that, in older adults [13], [14] and persons with musculoskeletal or neurological disorders such as transtibial amputation [15], Parkinson's disease [16], and stroke [17], gait characteristics derived from trunk acceleration, such as stride regularity, variability, and smoothness, are more sensitive to the risk of falling than typical gait characteristics such as gait speed and cadence. However, there are no studies that have investigated the associations between trunk performance and accelerometry-based gait characteristics in individuals following stroke.
The purpose of the present study was to investigate the association between trunk control and mobility performance and quantitative gait characteristics based on trunk accelerometry in patients with subacute stroke. We hypothesized that trunk motor control early after stroke would be independently related with mobility performance and accelerometry-based gait characteristics. Knowledge of the association of trunk control with mobility performance and accelerometry-based gait characteristics would provide valuable information for designing appropriate rehabilitation therapy programs to improve gait function following stroke.
Section snippets
Participants
This was a cross-sectional observational study performed between January and December 2013 in the rehabilitation center of an acute care hospital. This study was approved by the ethics committee of the hospital, and all participants gave informed consent.
Eligible patients with subacute stroke who were medically stable and underwent inpatient rehabilitation were recruited. Inclusion criteria were: (1) first ever stroke with unilateral hemiplegia and (2) able to walk 15 m without physical
Results
Fifteen patients with mild stroke severity (median NIHSS score, 2 [range, 1–7]; 10 ischemic, 5 hemorrhagic; 9 men, 6 women) were enrolled in this study. Median age was 61 years (range, 56–78 years). Median time since stroke was 9 days (range, 7–15 days). Five participants had left hemiparesis, and 10 were right-side affected. One subject used a single-point cane during the mobility performance tests, and none of the subjects wore a leg brace. Clinical measures and accelerometry variables are
Discussion
The primary finding of the present study was that trunk control measured with the TIS was closely associated with mobility performance and gait characteristics derived from trunk acceleration in adults with subacute stroke. Therefore, our hypothesis was supported. Our findings coincide with the previous study that has shown a significant relation between trunk performance and mobility in the non-acute and chronic phases following stroke [4], and might explain the transferring effect of trunk
Author contributions
Study concept and design: TI and SU; data acquisition: TI; data analysis and interpretation: TI; statistical analysis: TI and SU; drafting of the manuscript: TI; critical revision of the manuscript for important intellectual content: TI and SU; and approval of the final version of the manuscript: TI and SU.
Conflict of interest statement
None.
Acknowledgements
The authors thank Mr. Yosuke Suzuki (Shiraoka Orthopedics) for lending us the accelerometer and his helpful technical advices. The authors also thank the members of Professor Usuda's laboratory for helpful discussions.
References (32)
- et al.
Interstride trunk acceleration variability but not step width variability can differentiate between fit and frail older adults
Gait Posture
(2005) - et al.
Gait variability and regularity of people with transtibial amputations
Gait Posture
(2013) - et al.
Accelerometry-based gait characteristics evaluated using a smartphone and their association with fall risk in people with chronic stroke
J Stroke Cerebrovasc Dis
(2015) - et al.
Estimation of gait cycle characteristics by trunk accelerometry
J Biomech
(2004) - et al.
Acceleration patterns of the head and pelvis when walking on level and irregular surfaces
Gait Posture
(2003) - et al.
Analysis of stroke patient walking dynamics using a tri-axial accelerometer
Gait Posture
(2009) - et al.
Biomechanical impairments and gait adaptations post-stroke: multi-factorial associations
J Biomech
(2009) - et al.
Stroke affects the coordination and stabilization of head, thorax and pelvis during voluntary horizontal head motions performed in walking
Clin Neurophysiol
(2005) - et al.
Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke
Clin Biomech (Bristol, Avon)
(2014) - Ministry of Health, Labour and Welfare, Government of Japan [Internet]. Summary report of comprehensive survey of...
Time course of trunk, arm, leg, and functional recovery after ischemic stroke
Neurorehabil Neural Repair
Six-month functional recovery of stroke patients: a multi-time-point study
Int J Rehabil Res
Trunk performance after stroke and the relationship with balance, gait and functional ability
Clin Rehabil
Does trunk, arm, or leg control correlate best with overall function in stroke subjects?
Top Stroke Rehabil
Association of performance of standing turns with physical impairments and walking ability in patients with hemiparetic stroke
J Phys Ther Sci
Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients
Stroke
Cited by (46)
Validity and reliability of the Persian version of the trunk impairment scale in people with multiple sclerosis
2024, Multiple Sclerosis and Related DisordersThe immediate effects of lumbar rotational mobilization on trunk control and gait parameter in patients with stroke
2022, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The patients show difficulty in separating the movements between the chest and pelvis during gait.4 This impairment in trunk control leads to a decreased balance8 and gait ability.2 Therefore, trunk movement restriction causes trunk control impairment, resulting in a pathological gait.
Increased Trailing Limb Angle is Associated with Regular and Stable Trunk Movements in Patients with Hemiplegia
2022, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Previous studies measured the symmetry, regularity, and sway of trunk movements to evaluate the COG shift during walking by calculating the harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) using a wearable trunk accelerometer.11,12 These variables were associated with walking speed, hemiparetic severity, trunk motor impairment, and functional outcomes in post-stroke patients.13–16 Accelerometers provide a deeper understanding of the gait characteristics by analyzing the respective response patterns by vertical, lateromedial, and anteroposterior axes for motion measurements.11,17
Trunk kinematics during walking in stroke patients: A systematic review
2021, Rehabilitacion