The kinematic analysis of the trunk and weight-bearing symmetry in the three planes of movement during the four phases of sit-to-stand in adults with stroke and a community control group - case-control study

Steyn, Hesti (2018-12)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Introduction: The most frequent functional activity used in everyday life is sit-to-stand. Sit-to-stand (STS) consists of four phases with different pre-requisites for successful completion. The trunk plays an important role in a person with stroke’s ability to complete the transition. Objective: To describe trunk kinematics and weight-bearing symmetry during four phases of STS in three planes of movement in stroke participants and community controls. Secondly, to correlate the trunk impairment scale (TIS) of stroke participants with trunk kinematics and weight-bearing symmetry. Methods: Fifteen sub-acute stroke participants and fifteen community controls were included. Two inertial measurement units (myoMOTION) were used to capture upper and lower trunk kinematics during the four phases of STS. Phase 1 (P1) is the initiation phase, Phase 2 (P2) seat-off phase, Phase 3 (P3) is the extension phase and Phase 4 (P4) the standing stabilisation phase. MyoPRESSURE (Noraxon) was used to assess kinetics. Data was captured during five repeated STS from a standard chair at self-selected pace. All parameters were analysed in MATLAB (The Mathworks, Natrick, MA) using custom built scrips. Differences between case and control groups were calculated using non-parametric testing (95% CI, statistical significance level p<0.05). Correlation coefficients for secondary objectives were calculated using Spearman’s rho. Results: People with stroke (PWS) had a longer total and phases duration except during P2 (p<0.05) but showed decreased vertical acceleration (p=0.001). P1 was characterised by, weight transference onto the affected side as the unaffected foot moved backwards accompanied by thoracic side-flexion (p=0.037). From P2 to P4 the weight was transferred to the unaffected side. During P1 PWS moved the thoracic segment into rotation and side-flexion (p=0.001) but flexed forward the same distance as the controls at a slower velocity than the control group (p=0.016). The thoracic segment was moved at a high velocity into side-flexion and rotation for seat-off at the start of P2 (p<0.05). The control group displaced the lumbar segment into side flexion (p=0.033) and higher rotation ranges than PWS at seat-off (p=0.089). Control participants also showed increased lumbar flexion velocity (p=0.026). During P3, PWS showed greater thoracic velocity (p<0.05) during side-flexion and rotation displacement (p=0.001), but the lumbar segment extended at a slower velocity for the rest of P3 (p<0.05). In comparison, the control group had increased lumbar segment side-flexion and rotation ranges compared to PWS (p<0.05). During P4, PWS had increased thoracic side-flexion displacement to accompany asymmetrical weight-distribution (p=0.008). They deviated laterally with less smooth movement with increased thoracic and lumbar medio-lateral acceleration (p=0.001) and Jerk (p<0.05). The control group in contrast moved smoother in an anterior direction with increased thoracic antero-posterior (AP) acceleration (p=0.001). PWS and control participants had similar lumbar AP acceleration (p=0.902). Total TIS correlated positively with trunk angular velocity in P2, specifically thoracic forward flexion-rotation to the left plus lumbar forward flexion. TIS correlated with increased thoracic flexion displacement during P2. More thoracic extension displacement during P3 correlated with higher dynamic and coordination subscores. Decreased acceleration was associated with increased dynamic subscores. Increased dynamic and coordination subscores on the TIS correlated positively with more thoracic extension at the end of STS. Conclusion: PWS moved differently during STS compared to community controls. The thoracic segment moved more in frontal and transverse planes with fixation of the lumbar segment; potentially compensating for diminished postural control. Thoracic rotation and side-flexion may have been used to maintain a more central position and movement of the center of mass. The dynamic and coordination subscales of TIS, which highlight distinct impairments of the upper and lower trunk, correlated well with altered trunk kinematics of PWS.

AFRIKAANSE OPSOMMING : Inleiding: Die funksionele aktiwiteit wat elke dag die meeste gebruik word, is sit-tot-staan (STS). STS bestaan uit vier fases en elke fase het verskillende voorvereistes vir suksesvolle voltooiing. Die romp speel ‘n belangrike rol in die vermoë van persone met beroerte (PMB) om hierdie oorgang suksesvol te kan voltooi. Doel: Om die romp kinematika en gewigdraende asimmetrie gedurende die vier fases van STS in die drie vlakke van beweging in PMB en gemeenskapskontroles te beskryf. Tweedens, om die “Trunk Impairment Scale” (TIS) van deelnemers met hul romp kinematika en gewigdraende simmetrie te korreleer. Metodologie: Die gevallestudie het bestaan uit vyftien sub-akute deelnemers met beroerte, en vyftien gemeenskapskontroles. Twee traagheids-metings eenhede (myoMOTION) is gebruik om die boonste en onderste romp kinematika te meet gedurende die vier fases van STS. Fase 1 (F1) is die inleidings fase, Fase 2 (F2) sitplek verlating, Fase 3 is die ekstensie fase en Fase 4 (F4) die staan stabilisasie fase. MyoPRESSURE (Noraxon) is gebruik om die kinetika te meet. Die data is vasgelê gedurende vyf herhalings van STS vanaf ‘n gestandaardiseerde stoel teen ‘n self-gereguleerde tempo. Alle parameters is met MATLAB (The Mathworks, Natrick, MA) geanaliseer deur gebruik te maak van persoonlik ontwerpte formules. Die verskille tussen die gevallegroep en kontrolegroep is bereken deur gebruik te maak van nie-parametriese toetsing (95% CI, statistiese betekenisvolheidsvlak van p<0.05). Die korrelasie koëffisiënte vir sekondêre doelwitte is bereken deur gebruik te maak van Spearman se rho. Resultate: PMB het ‘n langer STS oorgang en fase tydsduur gehad behalwe gedurende F2 (p<0.05) maar het ‘n afname in vertikale versnelling getoon (p=0.001). F1 is gekenmerk deur gewigsoordrag op die geaffekteerde kant, aagesien die ongeaffekteerde voet agtertoe beweeg het. Dit is gevergesel deur torakale sy-fleksie (p=0.037). Van F2 tot F4 was die gewig oorgedra na die ongeaffekteerde kant. Gedurende F1 het die gevallegroep se torakale segment ‘n rotasie en sy-fleksie beweging getoon (p=0.001) terwyl die vorentoe fleksie dieselfde afstand as die kontrolegroep verplaas het teen ‘n stadiger snelheid (p=0.016). Die torakale segment het teen ‘n hoër snelheid in sy-fleksie en rotasie beweeg tydens sitplek verlating F2 (p<0.05). Die kontrolegroep se lumbale segment het in hoër sy-fleksie (p=0.033) en rotasie verplaas as PMB (p=0.089). Die kontrolegroep het ook ‘n verhoogte lumbale fleksie snelheid getoon (p=0.026). Gedurende F3 het PMB grooter torakale snelheid (p<0.05) getoon gedurende sy-fleksie en rotasie plaasgevind het. Die lumbale segment het stadiger ekstensie snelheid getoon vir die res van F3 (p<0.05). Die kontrolegroep het ‘n toename in beide lumbale segment sy-fleksie en rotasie grense gehad in vergelyking met PMB (p<0.05). Gedurende F4 het die gevallegroep ‘n toename in torakale sy-fleksie verplasing gehad om die ongeaffekteerde sy se gewigsverspreiding te akkommodeer (p=0.008). PMB het lateraal afgewyk met ‘n minder gladde beweging asook met verhoogde torakale en lumbale ML versnelling. (p=0.001) en ruk (p<0.05). Die kontrolegroep het in vergelyking ‘n gladder beweging in die AP rigting getoon vir die torakale segment (p=0.001). Beide die gevallegroep en die kontrolegroep het dieselfde lumbale AP versnelling gehad (p=0.902). Die totale TIS het ‘n positiewe korrelasie met die F2 hoeksnelheid getoon vir ‘n verhoogde torakale vorentoe fleksie, rotasie na links en lumbale vorentoe fleksie. Die TIS korreleer ook met ‘n toename in torakale fleksie grense gedurende F2. Hoër torakale ekstensie gedurende F3 korreleer met ‘n toename in die TIS, dinamiese subskaal en koördinasie subskaal lesing. ‘n Afname in versnelling word geassosieer met ‘n toename in die dinamiese subskaallesing. ‘n Toename in beide die dinamiese en koördinasie tellings is positief met meer torakale ekstensie aan die einde van STS. Gevolgtrekking: PMB beweeg verskillend tydens STS in vergelyking met die gemeenskapskontroles. Die torakale segment beweeg meer in die frontale- en dwarsvlak met fiksasie van die lumbale segment; wat moontlik vergoed vir die verminderede postuurbeheer. Torakale rotasie en sy-fleksie mag gebruik geword het om ‘n meer sentrale posisie en beweging van die middelpunt van massa te behou. Die dinamiese en koördinasie-subskale van TIS, dui sekere inkortings van die boonste en onderste romp aan. Dit het goed gekorreleer met die veranderde romp kinematika van die beroerte-deelnemers.

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