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People in the chronic phase post stroke have altered postural alignment in standing related to trunk performance and functional balance
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Research Report Platform Presentation Number: RR-PL-1801 Saturday 2 May 2015 16:44 Rooms 328–329 PEOPLE IN THE CHRONIC PHASE POST STROKE HAVE ALTERED POSTURAL ALIGNMENT IN STANDING RELATED TO TRUNK PERFORMANCE AND FUNCTIONAL BALANCE G. Verheyden 1,2 , C. Ruesen 3 , M. Gorissen 1 , V. Brumby 4 , R. Moran 4 , M. Burnett 4 , A. Ashburn 4 1 KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; 2 University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium; 3 Radboud University Medical Center, Department of Rehabilitation, Nijmegen, Netherlands; 4 University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom
Background: Trunk impairment, even in the chronic phase after stroke, is significantly related to balance, gait and functional ability, and is also significantly decreased longterm post stroke. Yet, underlying knowledge about why trunk control is impaired, is scarce. Due to post-stroke deficits, people post stroke might have an adapted postural alignment of the trunk. Purpose: The aim of our study was to investigate spinal postural alignment in people with chronic stroke and compare finding with an age-matched sample of healthy elderly. Secondary, we examined whether spinal postural alignment related to clinical measures of trunk performance, upper and lower limb function, balance, ADL and stroke impact. Methods: For this observational, cross-sectional study, we recruited people with chronic stroke (>6 months post stroke) and age-matched healthy elderly. Spinal postural alignment was determined by means of a standardized protocol using a hand-held electromechanical measurement device (SpinalMouse, Idiag AG, Switzerland). Measurements obtained included thoracic, lumbar, sacral, and overall postural alignment (inclination) in the sagittal plane. Measurements were acquired in the neutral upright, flexed forward and extended backward position in both sitting and standing. Clinical outcome measures included Trunk Impairment Scale (TIS), Fugl Meyer Assessment (FMA), Berg Balance Scale (BBS), Barthel Index (BI) and Stroke Impact Scale (SIS). Results: Twenty-one people with stroke (mean (SD) 67 (10) years, 9 females, mean time post stroke 7 (6.6) years) and 22 healthy elderly participated. Differences between people post stroke and healthy elderly were found for the standing position: people post stroke had a significantly greater forward inclination in the neutral upright position (p = 0.002); they showed less anterior pelvic tilt (p = 0.001) and less forward inclination (p = 0.003) when standing flexed forward;
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and less posterior pelvic tilt (p = 0.014) and less backward inclination (p < 0.001) when standing extended backward. These findings were significantly related to clinical outcome measures: people post stroke with a less forward inclined posture when standing upright had a better score on the coordination subscale of the TIS (r = −0.61) and BBS (r = −0.64). Participants with stroke who showed more anterior pelvic tilt when flexed forward had better scores on the dynamic sitting balance (r = 0.70) and coordination (r = 0.73) subscales of the TIS, as well as the total TIS (r = 0.62). Subjects post stroke with more forward inclination in the flexed forward position had better scores on the dynamic sitting balance subscale of the TIS (r = 0.65). People with stroke with more backward inclination when standing extended backward scored better on the coordination subscale of the TIS (r = −0.64) and BBS (r = −0.60, negative values due to backward inclination expressed as negative value). Conclusion(s): People in the chronic phase after stroke have an altered postural alignment in standing in comparison with healthy elderly, especially concerning anterior and posterior pelvic tilt. Significant relations between altered postural alignment and clinical measures of trunk performance and functional balance might indicate the functional importance of our findings. Implications: Physical therapy for people in the chronic phase post stroke could additionally consider measurement and treatment of anterior and posterior pelvic tilt position and mobility. Evaluating chronic post-stroke interventions that incorporate increase in pelvic tilt seems warranted. Keywords: Stroke; Postural alignment; Clinical measures Funding acknowledgements: This study was not funded. Ethics approval: Ethical approval was obtained from the Faculty of Health Sciences Ethics Committee of the University of Southampton. http://dx.doi.org/10.1016/j.physio.2015.03.1590 Special Interest Report Platform Rapid 5 Presentation Number: SI-PLR5-2900 Monday 4 May 2015 08:30 Rooms 324–326 IMPLEMENTING ONLINE EXAMINATION INCORPORATING VIDEO CASES IN A PHYSICAL THERAPY CURRICULUM. RESULTS FROM A UNIVERSITY-FUNDED EDUCATIONAL PROJECT G. Verheyden, B. Vandendoorent, K. Desloovere, A. Nieuwboer, H. Feys, F. Staes KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium Background: Due to technological advances, video cases have become a widespread educational medium. At KU
Research Report Platform Presentation Number: RR-PL-1801 Saturday 2 May 2015 16:44 Rooms 328–329 PEOPLE IN THE CHRONIC PHASE POST STROKE HAVE ALTERED POSTURAL ALIGNMENT IN STANDING RELATED TO TRUNK PERFORMANCE AND FUNCTIONAL BALANCE G. Verheyden 1,2 , C. Ruesen 3 , M. Gorissen 1 , V. Brumby 4 , R. Moran 4 , M. Burnett 4 , A. Ashburn 4 1 KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; 2 University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium; 3 Radboud University Medical Center, Department of Rehabilitation, Nijmegen, Netherlands; 4 University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom
Background: Trunk impairment, even in the chronic phase after stroke, is significantly related to balance, gait and functional ability, and is also significantly decreased longterm post stroke. Yet, underlying knowledge about why trunk control is impaired, is scarce. Due to post-stroke deficits, people post stroke might have an adapted postural alignment of the trunk. Purpose: The aim of our study was to investigate spinal postural alignment in people with chronic stroke and compare finding with an age-matched sample of healthy elderly. Secondary, we examined whether spinal postural alignment related to clinical measures of trunk performance, upper and lower limb function, balance, ADL and stroke impact. Methods: For this observational, cross-sectional study, we recruited people with chronic stroke (>6 months post stroke) and age-matched healthy elderly. Spinal postural alignment was determined by means of a standardized protocol using a hand-held electromechanical measurement device (SpinalMouse, Idiag AG, Switzerland). Measurements obtained included thoracic, lumbar, sacral, and overall postural alignment (inclination) in the sagittal plane. Measurements were acquired in the neutral upright, flexed forward and extended backward position in both sitting and standing. Clinical outcome measures included Trunk Impairment Scale (TIS), Fugl Meyer Assessment (FMA), Berg Balance Scale (BBS), Barthel Index (BI) and Stroke Impact Scale (SIS). Results: Twenty-one people with stroke (mean (SD) 67 (10) years, 9 females, mean time post stroke 7 (6.6) years) and 22 healthy elderly participated. Differences between people post stroke and healthy elderly were found for the standing position: people post stroke had a significantly greater forward inclination in the neutral upright position (p = 0.002); they showed less anterior pelvic tilt (p = 0.001) and less forward inclination (p = 0.003) when standing flexed forward;
eS1585
and less posterior pelvic tilt (p = 0.014) and less backward inclination (p < 0.001) when standing extended backward. These findings were significantly related to clinical outcome measures: people post stroke with a less forward inclined posture when standing upright had a better score on the coordination subscale of the TIS (r = −0.61) and BBS (r = −0.64). Participants with stroke who showed more anterior pelvic tilt when flexed forward had better scores on the dynamic sitting balance (r = 0.70) and coordination (r = 0.73) subscales of the TIS, as well as the total TIS (r = 0.62). Subjects post stroke with more forward inclination in the flexed forward position had better scores on the dynamic sitting balance subscale of the TIS (r = 0.65). People with stroke with more backward inclination when standing extended backward scored better on the coordination subscale of the TIS (r = −0.64) and BBS (r = −0.60, negative values due to backward inclination expressed as negative value). Conclusion(s): People in the chronic phase after stroke have an altered postural alignment in standing in comparison with healthy elderly, especially concerning anterior and posterior pelvic tilt. Significant relations between altered postural alignment and clinical measures of trunk performance and functional balance might indicate the functional importance of our findings. Implications: Physical therapy for people in the chronic phase post stroke could additionally consider measurement and treatment of anterior and posterior pelvic tilt position and mobility. Evaluating chronic post-stroke interventions that incorporate increase in pelvic tilt seems warranted. Keywords: Stroke; Postural alignment; Clinical measures Funding acknowledgements: This study was not funded. Ethics approval: Ethical approval was obtained from the Faculty of Health Sciences Ethics Committee of the University of Southampton. http://dx.doi.org/10.1016/j.physio.2015.03.1590 Special Interest Report Platform Rapid 5 Presentation Number: SI-PLR5-2900 Monday 4 May 2015 08:30 Rooms 324–326 IMPLEMENTING ONLINE EXAMINATION INCORPORATING VIDEO CASES IN A PHYSICAL THERAPY CURRICULUM. RESULTS FROM A UNIVERSITY-FUNDED EDUCATIONAL PROJECT G. Verheyden, B. Vandendoorent, K. Desloovere, A. Nieuwboer, H. Feys, F. Staes KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium Background: Due to technological advances, video cases have become a widespread educational medium. At KU