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Relationship between sit-to-stand (STS) motion characteristics and walking ability in stroke patients
Abstracts / Gait & Posture 36 (2012) S1–S101
S57
Fig. 1.
sedentary group (SG), the active group (AG) and very active group (VAG). The average age was 69.44 ± 6.43. To collect data we used a pressure platform, Fusyo brand, whereas prior to testing patients responded to the IPAQ to characterize the levels of physical activity (PA). Results: The elderly from VAG showed higher AP, ML and area body sway compared with both the AG and with SG, with eyes open and eyes closed, taking significance as p < 0.05. Fig. 1 – variation of COP oscillation of the total area of SG, AG and VAG. Discussion and conclusion: This study allows the analysis of a larger displacement of the COP in the antero-posterior and medial–lateral directions in very active elderly, showing greater sway the higher the level of physical activity. Therefore, we believe that this oscillation is increased by the improvement of joint mobility in the physically active elderly as well as postural strategies. Disclosure: No significant relationships. References [1] Sherrington C, Lord SR, Vogler CM, Close JCT, Brraclough E, Ramsay E, et al. Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomized controlled trial and economic evaluation. BMC Geriatrics 2009;9(8):1–7. [2] Beynon CM, Roe B, Duffy P, Pickering L. Self reported health status, and health service contact, of illicit drug users aged 50 and over: a qualitative interview study in Merseyside, United Kingdom. BMC Geriatrics 2009;9(45):1–27. [3] Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Medical Journal 2009;32:297–304.
doi:10.1016/j.gaitpost.2011.10.276 P04 Relationship between sit-to-stand (STS) motion characteristics and walking ability in stroke patients N. Maeda 1,∗ , J. Kato 2 , K. Itotani 1 , K. Onishi 1 , M. Murakami 3 1
Physical Therapy, Hyogo Prefectural Rehabilitation Center at Nishiharima, Tatsuno, Japan 2 Internal Medicine, Hyogo Prefectural Rehabilitation Center at Nishiharima, Tatsuno, Japan 3 Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, Japan Introduction: Sit to stand (STS) motion is among the most commonly executed daily activities. Mean loading of the hemiplegic limb during STS has been shown to range from 24% to 37% of body weight [1,2]. Stroke patient also show a larger center of pressure (COP) sway in the mediolateral direction, have a significantly lower
rate of rise in force, and take longer to complete the STS [1]. The previous study reported that STS performance correlates with walking speed, independent ambulation for elderly persons. Although there have been only a few reports that have focused the relation between STS and clinical walking ability test for stroke. Therefore, the aim of this present study was to investigate the relationship between sit to stand motion and walking ability for stroke patients. Patients/materials and methods: Participants included 15 stroke patients (11 male and four female; 61 ± 9 years) hospitalized in the Nishi-Harima Rehabilitation Central Hospital stood still and performed STS motion on two force plates (G-620, Anima Co. Ltd., Japan). Walking ability was classified into two groups: unaided walking in the hospital (n = 9), unaided walking in inpatient’s room (n = 6). And the time required STS motion was calculated from the vertical ground reaction forces. STS motion was divided into three phases and the vertical ground reaction forces were calculated for each phase. In addition, postural sway after STS motion used a coefficient of variance (CV) of the vertical ground reaction forces. 6 min walking distance and 10 m gait speed indices of gait ability. TUG indices of balance ability. Data are expressed as mean ± SD. Student’s t-test processed by the SPSS® statistical package for Windows® , was used for the testing of differences between Two groups. Significance was set at P less than 0.05. Results: The characteristics of the stroke patients and statistical comparisons between unaided walking in the hospital and unaided walking in inpatient’s room groups are shown in Table 2. As a result, Rate of rise in force (%BW/s) required STS motion and CV after STS motion was significantly larger in the group of unaided walking in inpatient’s room than in the group of unaided walking in the hospital (P < 0.05). The correlation coefficients for the variables show a strong correlation between CV and 10 m gait speed (r = 0.85, P < 0.01), TUG (r = 0.69, P < 0.01) (Table 3). Discussion and conclusion: These results suggest that STS motion may be useful measure for identifying walking ability in chronic stroke inpatients. Postural sway after STS motion is closely related to gait and balance ability in stroke patients. Finally, to make these tests truly useful to the clinician, we also need studies to establish whether these tests are sensitive enough to measure change over time in the presence of rehabilitation interventions. Disclosure: No significant relationships.
References [1] Cheng PT, Liaw MY, Wong MK, Tang FT, Lee MY, Lin PS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil 1998;67:1043–6.
S58
Abstracts / Gait & Posture 36 (2012) S1–S101
[2] Engardt M. Rising and sitting down in stroke patients. Auditory feedback and dynamic strength training to enhance symmetrical body weight distribution. Scand J Rehabil Med Suppl 1994;31:1–57.
doi:10.1016/j.gaitpost.2011.10.277 P05 Static balance among children with Down Syndrome B.G. Ribeiro 1 , L.A.C. Grecco 1 , J.C.F. Corrêa 1 , P.R.G. Lucareli 1 , A. Salgado 2 , C.S. Oliveira 1,∗
References [1] Butterworth G, Cicchetti D. Visual calibration of posture in normal and motor retarded Down’s syndrome infants. Perception 1978;7(5):513–25. [2] Vuillerme N, Marin L, Debu B. Assessment of static postural control in teenagers with Down syndrome. Adapt Phys Activ Q 2001;18:417–33. [3] Meneghetti CHZ, Blascovi-Assis SM, Deloroso FT, Rodrigues GM. Static balance assessment among children and adolescents with Down syndrome. Rev Bras Fisiotr 2009;13(3):230–5.
doi:10.1016/j.gaitpost.2011.10.278 P06
1
Laboratory of Human Movement Byodinamics, University Nove de Julho, São Paulo, Brazil 2 Unicastelo, São Paulo, Brazil Introduction: According to some authors [1–3], children with Down Syndrome (DS) oscillate more than children with no neuromotor impairment during static posture control, which is attributed to difficulty capturing the sensory information that determines the position of the body in space [1,2]. The aim of the present study was to assess static balance among children with DS through a stabilometric evaluation and determine the influence of vision over static balance. Patients/materials and methods: A non-controlled crosssectional study was carried out involving 14 children – seven with DS and seven with normal development (control group) – between eight and 12 years of age. A Medicapteurs Fusyo force plate was used for the evaluation of static balance. The participants were assessed in the orthostatic position on the platform, barefoot and with no restrictions regarding the base of the feet. Oscillations in the anteroposterior and mediolateral directions and total area of oscillation were recorded under the conditions of eyes open and eyes closed. The non-paired Student’s t-test was used for the inter-group comparisons of mean values and the paired t-test was used for the intra-group comparisons, with the level of significance set at 0.05. Results: Mean age was 9.8 ± 0.5 years in the group with DS and 10.0 ± 0.4 in the control group. Table 1 displays the results of the oscillation analysis. Statistically significant differences were detected between groups in anteroposterior oscillation with eyes open and eyes closed (p = 0.00). No statistically significant intragroup or inter-group differences were detected regarding the other variables (p > 0.05). Discussion and conclusion: The children with Down Syndrome analyzed in the present study exhibited greater anteroposterior oscillation with and without visual information. The greater anteroposterior oscillation did not lead to a significant change in the area of overall oscillation in comparison to the children with normal development. Vision did not affect static balance in the sample studied. Disclosure: No significant relationships.
Interference of high-heel shoes in static balance among young women S.B. Gerber 1 , R.V. Costa 1 , L.A.C. Grecco 1 , H. Pasini 1 , J.C.F. Corrêa 1 , P.R.G. Lucareli 1 , A. Salgado 2 , C.S. Oliveira 3,∗ 1 Laboratory of Human Movement Biodynamics, University Nove de Julho, São Paulo, Brazil 2 Unicastelo, São Paulo, Brazil 3 Physiotherapy, UNINOVE, São Paulo – SP, Brazil
Introduction: The use of high-heeled shoes leads to alterations to the support base, center of pressure of the feet on the ground and height of the center of gravity in relation to the support base, thereby directly influencing the stability of the body [1,2]. The aim of the present study was to analyze the interference of high-heeled shoes in the static balance of young women, comparing the degree of body oscillation in the anteroposterior and mediolateral directions with and without visual information. Patients/materials and methods: A non-controlled crosssectional study was carried out involving 53 women between 18 and 30 years of age. Anthropometric characteristics of the sample were determined. An OR-6 force plate (AMTI) was used for the evaluation of static balance. The participants were assessed in the orthostatic position on the platform under four conditions: (1) barefoot with eyes open; (2) barefoot with eyes closed; (3) in high heels with eyes open; and (4) in high heels with eyes closed. The same model of shoe was used by all participants, measuring 7 cm in height and 1 cm in diameter. Oscillations in the anteroposterior and mediolateral directions were recorded. Two-way ANOVA was employed in the statistical analysis, with the level of significance set at 0.05. Results: Mean age of the participants was 23.3 ± 5.1 years. Mean oscillations in the anteroposterior and mediolateral directions were greater with the use of high-heeled shoes and statistically significant differences were detected between the conditions of eyes open and eyes closed (p < 0.05). With the use of high heels, greater oscillations occurred in the anteroposterior direction than the mediolateral direction with eyes open (p = 0.04) and eyes closed (p = 0.00). Barefoot eyes open
High heels eyes open
High heels eyes closed
Anteroposterior 0.022 ± 0.001 0.027 ± 0.002 0.029 ± 0.002 0.038 ± 0.003 Mediolateral 0.013 ± 0.001 0.014 ± 0.001 0.022 ± 0.010 0.024 ± 0.012
Table 1 Oscillations from center of pressure with eyes open and eyes closed. Oscillation
Barefoot eyes closed
Group with Down Syndrome
Control group
Eyes open
Eyes closed
Eyes open
Eyes closed
Anteroposterior Mediolateral
1.2 ± 0.3 7.5 ± 4.9
1.2 ± 0.3 9.4 ± 5.2
1.0 ± 0.7 5.1 ± 1.9
1.0 ± 0.8 6.4 ± 2.9
Total area
6.5 ± 2.5
8.2 ± 3.9
8.5 ± 6.1
10.3 ± 6.2
Discussion and conclusion: The results of the present study corroborate those reported in a previous study [3], which demonstrated that the use of high-heeled shoes causes instability of the feet due to the inversion of the ankle stemming from fatigue of the gastrocnemius and peroneus longus muscles. The change in the support base in terms of height and diameter compromises proprioceptive sensory information necessary for adequate postural control. The use of 7-cm high heels compromised the static balance of the women studied, leading to greater oscillations in the anteroposterior and mediolateral directions, especially with visual information was removed.
S57
Fig. 1.
sedentary group (SG), the active group (AG) and very active group (VAG). The average age was 69.44 ± 6.43. To collect data we used a pressure platform, Fusyo brand, whereas prior to testing patients responded to the IPAQ to characterize the levels of physical activity (PA). Results: The elderly from VAG showed higher AP, ML and area body sway compared with both the AG and with SG, with eyes open and eyes closed, taking significance as p < 0.05. Fig. 1 – variation of COP oscillation of the total area of SG, AG and VAG. Discussion and conclusion: This study allows the analysis of a larger displacement of the COP in the antero-posterior and medial–lateral directions in very active elderly, showing greater sway the higher the level of physical activity. Therefore, we believe that this oscillation is increased by the improvement of joint mobility in the physically active elderly as well as postural strategies. Disclosure: No significant relationships. References [1] Sherrington C, Lord SR, Vogler CM, Close JCT, Brraclough E, Ramsay E, et al. Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomized controlled trial and economic evaluation. BMC Geriatrics 2009;9(8):1–7. [2] Beynon CM, Roe B, Duffy P, Pickering L. Self reported health status, and health service contact, of illicit drug users aged 50 and over: a qualitative interview study in Merseyside, United Kingdom. BMC Geriatrics 2009;9(45):1–27. [3] Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Medical Journal 2009;32:297–304.
doi:10.1016/j.gaitpost.2011.10.276 P04 Relationship between sit-to-stand (STS) motion characteristics and walking ability in stroke patients N. Maeda 1,∗ , J. Kato 2 , K. Itotani 1 , K. Onishi 1 , M. Murakami 3 1
Physical Therapy, Hyogo Prefectural Rehabilitation Center at Nishiharima, Tatsuno, Japan 2 Internal Medicine, Hyogo Prefectural Rehabilitation Center at Nishiharima, Tatsuno, Japan 3 Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, Japan Introduction: Sit to stand (STS) motion is among the most commonly executed daily activities. Mean loading of the hemiplegic limb during STS has been shown to range from 24% to 37% of body weight [1,2]. Stroke patient also show a larger center of pressure (COP) sway in the mediolateral direction, have a significantly lower
rate of rise in force, and take longer to complete the STS [1]. The previous study reported that STS performance correlates with walking speed, independent ambulation for elderly persons. Although there have been only a few reports that have focused the relation between STS and clinical walking ability test for stroke. Therefore, the aim of this present study was to investigate the relationship between sit to stand motion and walking ability for stroke patients. Patients/materials and methods: Participants included 15 stroke patients (11 male and four female; 61 ± 9 years) hospitalized in the Nishi-Harima Rehabilitation Central Hospital stood still and performed STS motion on two force plates (G-620, Anima Co. Ltd., Japan). Walking ability was classified into two groups: unaided walking in the hospital (n = 9), unaided walking in inpatient’s room (n = 6). And the time required STS motion was calculated from the vertical ground reaction forces. STS motion was divided into three phases and the vertical ground reaction forces were calculated for each phase. In addition, postural sway after STS motion used a coefficient of variance (CV) of the vertical ground reaction forces. 6 min walking distance and 10 m gait speed indices of gait ability. TUG indices of balance ability. Data are expressed as mean ± SD. Student’s t-test processed by the SPSS® statistical package for Windows® , was used for the testing of differences between Two groups. Significance was set at P less than 0.05. Results: The characteristics of the stroke patients and statistical comparisons between unaided walking in the hospital and unaided walking in inpatient’s room groups are shown in Table 2. As a result, Rate of rise in force (%BW/s) required STS motion and CV after STS motion was significantly larger in the group of unaided walking in inpatient’s room than in the group of unaided walking in the hospital (P < 0.05). The correlation coefficients for the variables show a strong correlation between CV and 10 m gait speed (r = 0.85, P < 0.01), TUG (r = 0.69, P < 0.01) (Table 3). Discussion and conclusion: These results suggest that STS motion may be useful measure for identifying walking ability in chronic stroke inpatients. Postural sway after STS motion is closely related to gait and balance ability in stroke patients. Finally, to make these tests truly useful to the clinician, we also need studies to establish whether these tests are sensitive enough to measure change over time in the presence of rehabilitation interventions. Disclosure: No significant relationships.
References [1] Cheng PT, Liaw MY, Wong MK, Tang FT, Lee MY, Lin PS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil 1998;67:1043–6.
S58
Abstracts / Gait & Posture 36 (2012) S1–S101
[2] Engardt M. Rising and sitting down in stroke patients. Auditory feedback and dynamic strength training to enhance symmetrical body weight distribution. Scand J Rehabil Med Suppl 1994;31:1–57.
doi:10.1016/j.gaitpost.2011.10.277 P05 Static balance among children with Down Syndrome B.G. Ribeiro 1 , L.A.C. Grecco 1 , J.C.F. Corrêa 1 , P.R.G. Lucareli 1 , A. Salgado 2 , C.S. Oliveira 1,∗
References [1] Butterworth G, Cicchetti D. Visual calibration of posture in normal and motor retarded Down’s syndrome infants. Perception 1978;7(5):513–25. [2] Vuillerme N, Marin L, Debu B. Assessment of static postural control in teenagers with Down syndrome. Adapt Phys Activ Q 2001;18:417–33. [3] Meneghetti CHZ, Blascovi-Assis SM, Deloroso FT, Rodrigues GM. Static balance assessment among children and adolescents with Down syndrome. Rev Bras Fisiotr 2009;13(3):230–5.
doi:10.1016/j.gaitpost.2011.10.278 P06
1
Laboratory of Human Movement Byodinamics, University Nove de Julho, São Paulo, Brazil 2 Unicastelo, São Paulo, Brazil Introduction: According to some authors [1–3], children with Down Syndrome (DS) oscillate more than children with no neuromotor impairment during static posture control, which is attributed to difficulty capturing the sensory information that determines the position of the body in space [1,2]. The aim of the present study was to assess static balance among children with DS through a stabilometric evaluation and determine the influence of vision over static balance. Patients/materials and methods: A non-controlled crosssectional study was carried out involving 14 children – seven with DS and seven with normal development (control group) – between eight and 12 years of age. A Medicapteurs Fusyo force plate was used for the evaluation of static balance. The participants were assessed in the orthostatic position on the platform, barefoot and with no restrictions regarding the base of the feet. Oscillations in the anteroposterior and mediolateral directions and total area of oscillation were recorded under the conditions of eyes open and eyes closed. The non-paired Student’s t-test was used for the inter-group comparisons of mean values and the paired t-test was used for the intra-group comparisons, with the level of significance set at 0.05. Results: Mean age was 9.8 ± 0.5 years in the group with DS and 10.0 ± 0.4 in the control group. Table 1 displays the results of the oscillation analysis. Statistically significant differences were detected between groups in anteroposterior oscillation with eyes open and eyes closed (p = 0.00). No statistically significant intragroup or inter-group differences were detected regarding the other variables (p > 0.05). Discussion and conclusion: The children with Down Syndrome analyzed in the present study exhibited greater anteroposterior oscillation with and without visual information. The greater anteroposterior oscillation did not lead to a significant change in the area of overall oscillation in comparison to the children with normal development. Vision did not affect static balance in the sample studied. Disclosure: No significant relationships.
Interference of high-heel shoes in static balance among young women S.B. Gerber 1 , R.V. Costa 1 , L.A.C. Grecco 1 , H. Pasini 1 , J.C.F. Corrêa 1 , P.R.G. Lucareli 1 , A. Salgado 2 , C.S. Oliveira 3,∗ 1 Laboratory of Human Movement Biodynamics, University Nove de Julho, São Paulo, Brazil 2 Unicastelo, São Paulo, Brazil 3 Physiotherapy, UNINOVE, São Paulo – SP, Brazil
Introduction: The use of high-heeled shoes leads to alterations to the support base, center of pressure of the feet on the ground and height of the center of gravity in relation to the support base, thereby directly influencing the stability of the body [1,2]. The aim of the present study was to analyze the interference of high-heeled shoes in the static balance of young women, comparing the degree of body oscillation in the anteroposterior and mediolateral directions with and without visual information. Patients/materials and methods: A non-controlled crosssectional study was carried out involving 53 women between 18 and 30 years of age. Anthropometric characteristics of the sample were determined. An OR-6 force plate (AMTI) was used for the evaluation of static balance. The participants were assessed in the orthostatic position on the platform under four conditions: (1) barefoot with eyes open; (2) barefoot with eyes closed; (3) in high heels with eyes open; and (4) in high heels with eyes closed. The same model of shoe was used by all participants, measuring 7 cm in height and 1 cm in diameter. Oscillations in the anteroposterior and mediolateral directions were recorded. Two-way ANOVA was employed in the statistical analysis, with the level of significance set at 0.05. Results: Mean age of the participants was 23.3 ± 5.1 years. Mean oscillations in the anteroposterior and mediolateral directions were greater with the use of high-heeled shoes and statistically significant differences were detected between the conditions of eyes open and eyes closed (p < 0.05). With the use of high heels, greater oscillations occurred in the anteroposterior direction than the mediolateral direction with eyes open (p = 0.04) and eyes closed (p = 0.00). Barefoot eyes open
High heels eyes open
High heels eyes closed
Anteroposterior 0.022 ± 0.001 0.027 ± 0.002 0.029 ± 0.002 0.038 ± 0.003 Mediolateral 0.013 ± 0.001 0.014 ± 0.001 0.022 ± 0.010 0.024 ± 0.012
Table 1 Oscillations from center of pressure with eyes open and eyes closed. Oscillation
Barefoot eyes closed
Group with Down Syndrome
Control group
Eyes open
Eyes closed
Eyes open
Eyes closed
Anteroposterior Mediolateral
1.2 ± 0.3 7.5 ± 4.9
1.2 ± 0.3 9.4 ± 5.2
1.0 ± 0.7 5.1 ± 1.9
1.0 ± 0.8 6.4 ± 2.9
Total area
6.5 ± 2.5
8.2 ± 3.9
8.5 ± 6.1
10.3 ± 6.2
Discussion and conclusion: The results of the present study corroborate those reported in a previous study [3], which demonstrated that the use of high-heeled shoes causes instability of the feet due to the inversion of the ankle stemming from fatigue of the gastrocnemius and peroneus longus muscles. The change in the support base in terms of height and diameter compromises proprioceptive sensory information necessary for adequate postural control. The use of 7-cm high heels compromised the static balance of the women studied, leading to greater oscillations in the anteroposterior and mediolateral directions, especially with visual information was removed.