Browsing by Author "Steyn, Hesti"
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- ItemThe 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(Stellenbosch : Stellenbosch University, 2018-12) Steyn, Hesti; Inglis-Jassiem, Gakeemah; Titus, Adnil; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.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.