The sit-to-stand movement in stroke patients and its correlation with falling

doi:10.1016/S0003-9993(98)90168-X

Archives of Physical Medicine and Rehabilitation

Volume 79, Issue 9, September 1998, Pages 1043-1046

https://doi.org/10.1016/S0003-9993(98)90168-X Get rights and content

Abstract

Objective: To use kinetic assessment of the sit-to-stand movement as a means of sorting out those stroke patients at risk for falling.

Design: A retrospective study, using a force platform to assess sit-to-stand performance and to determine its correlation with falls in stroke patients.

Setting: Hospital-based rehabilitation units.

Methods: Thirty-three stroke patients (18 fallers, 15 nonfallers) and 25 age-matched healthy subjects were included in this study. Subjects sat in an adjustable chair with their feet on two force plates and performed the standing up/sitting down movement at a self-paced, comfortable speed.

Results: The rate of rise in force (dF/dT) was significantly lower in stroke fallers than in stroke nonfallers and healthy subjects (23.78 ± 17.38, 55.23 ± 31.24, and 85.96 ± 42.4 percent body weight per second, respectively [p < .005]). The center of pressure sway in mediolateral direction during rising/ sitting down was much greater in stroke fallers than in stroke nonfallers or healthy subjects (p < .05). Body weight distribution was asymmetric on the feet of stroke patients, with much more body weight on their sound side.

Conclusions: The significantly lower rate of rise in force and greater postural sway while rising/sitting down may be useful in identifying stroke patients who are at risk for falling.

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Increased hip adductor activation during sit-to-stand improves muscle activation timing and rising-up mechanics in individuals with hemiparesis
2023, Journal of Electromyography and Kinesiology
Long sit-to-stand (STS) time has been identified as a feature of impaired functional mobility. The changes in biomechanics of STS performance with simultaneous hip adductor contraction have not been studied, which may limit indications for use of hip adductor activation during STS training.
Ten individuals with hemiplegia (mean age 61.8 years, injury time 29.8 ± 15.2 months) performed the STS with and without squeezing a ball between two legs. The joint moments, ground reaction force (GRF), chair reaction force and movement durations and temporal index of electromyography were calculated from the control condition for comparison with those from the ball squeezing condition.
Under the squeeze condition, reduced peak vertical GRF during the ascension phase with increased loading rate was observed in the nonparetic limb, and the peak knee extensor moment occurred earlier in the paretic. Earlier activation of tibialis anterior and gluteus maximus, and gluteus medius were found in squeeze STS.
Squeezing a ball between limbs during STS increased the contraction timing of tibialis anterior, gluteus maximus, gluteus medius, and soleus as well as a more symmetric rising mechanics encourage the use of squeezing a ball between limbs during STS for individuals with hemiparesis.
Trunk and lower extremity biomechanics during sit-to-stand after stroke: A systematic review
2023, Annals of Physical and Rehabilitation Medicine
This systematic review aimed to pool available evidence of differences in trunk and lower extremity biomechanics during the different phases of a sit-to-stand (STS) task between persons with stroke and to healthy controls.
Four electronic databases (Medline, Web of Science, EMBASE, and Cochrane Library) were systematically searched up to, and including, December 2021. Studies were included if they investigated kinematic, kinetic and/or electromyographic outcome measures of adults with stroke during STS and compared results with healthy controls. Data from eligible studies were categorized according to STS subphases if reported (Phase I: Movement onset to seat-off; Seat-off; Phase II: Seat-off to movement termination; Whole task [if no subtasks reported]). The Newcastle-Ottawa Scale was used to assess risk of bias.
Twenty-one studies were included in this systematic review. Methodological quality ranged from 13% to 75%; mean score was 55%. The findings of this systematic review suggest that after stroke, people rise to stand (phase I) with increased lateral trunk flexion and displacement of the center of pressure (COP) towards the non-paretic side, decreased anterior pelvic tilt, decreased hip flexion and altered timing of lower limb muscle activation. In addition, during phase II, lateral pelvic translation and weight distribution asymmetry was increased, knee extension velocity was decreased and delayed, stabilization was decreased and COP velocity was increased compared with healthy subjects.
This systematic review clearly showed changes in kinematics, kinetics and muscle recruitment after stroke, with differences between the different phases of STS. Therapeutic interventions should focus on subphases of this functional task to optimize performance in daily living.
The effects of anterior and posterior ankle-foot orthoses on sit-to-stand transfer performance in stroke patients
2022, Gait and Posture
Nonarticulated and low-temperature thermoplastic ankle–foot orthoses (AFOs) have a semirigid design and are effective in improving the postural control mechanism (PCM) in individuals with poststroke hemiparesis. AFOs with an anterior leaf (AAFOs) are more often prescribed than are AFOs with a posterior leaf (PAFOs); however, the effects of AAFOs on the PCM during sit-to-stand transfer (STST) have not been explored.
Do AAFOs and PAFOs change the PCM differently during STST?
A cross-sectional quasi-experimental design was adopted in this study. Fourteen individuals with poststroke hemiparesis (10 men and 4 women, aged between 38 and 71 years, stroke onset between 1 and 17 months) performed STST with shoes only, an AAFO with shoes, or a PAFO with shoes. Vertical ground reaction force (VGRF) and center-of-pressure (CoP) coordinates were collected using a pressure mat to calculate PCM parameters. A single-factor repeated measures analysis of variance was performed to answer the research question.
(1) The weight-bearing percentage of the paretic leg was significantly lower when the participants wore a PAFO (p = 0.018) than when they wore an AAFO (p = 0.019) during the first 5 and 5–10 s after rising. (2) A small rate of change of the VGRF increment (dF/dT) was detected when participants wore AFOs, particularly AAFO. (3) The maximum mediolateral displacement of the CoP when standing up was significantly different among the three conditions (p = 0.012).
For patients with poststroke hemiparesis, AAFO and PAFOs change the PCM during STST performance. Only AAFO improved the PCM possibly because of the rigidity and clearance of the heel region, which provide somatic sensory feedback. Therefore, rehabilitation professionals should educate hemiplegic patients who use AAFOs or PAFOs to perform dynamic daily tasks slowly for their safety.
Gait evaluation in stroke hemiplegic patients using short physical performance battery
2022, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Therefore, SIDE is highly useful in clinical situations for fall prediction22 and SPPB, which includes items that resemble SIDE items, would be useful in fall prediction. It was reported that people who experienced a fall took longer for the 30-s stand-up test than those who did not experience a fall.35 The risk of falling increases when the walking speed decreases to <1.0 km/h,36 and faster walking speed was associated with a higher level of walking independence.37
Falls can occur daily in stroke patients and appropriate independence assessments for fall prevention are required. Although previous studies evaluated the short physical performance battery (SPPB) in stroke patients, the relationship between SPPB and fall prediction and walking independence remains unclear. Therefore, we aimed to verify whether SPPB is a predictor of walking independence.
The present study included 105 hemiplegic stroke patients who were admitted to the rehabilitation ward and gave consent to participate. Cross-sectional physical function and functional independence measure cognitive (FIM-C) evaluation were conducted in hemiplegic stroke patients. Logistic regression analysis using the increasing variable method (likelihood ratio) was performed to extract factors for walking independence. Cutoff values were calculated for the extracted items using the receiver operating-characteristic (ROC) curve.
Among 86 participants included in the final analysis, 36 were independent walkers and 50 were dependent walkers. In the logistic regression analysis, SPPB and FIM-C were extracted as factors for walking independence. The cutoff value was 7 [area under the curve (AUC), 0.94; sensitivity, 0.83; specificity, 0.73)] for SPPB and 32 (AUC, 0.83; sensitivity, 0.69; specificity, 0.57) for FIM-C in ROC analysis
SPPB and FIM-C were extracted as factors for walking independence. Although SPPB alone cannot determine independent walking, combined assessment of SPPB with cognitive function may enable more accurate determination of walking independence.
Effects of a specific aquatic therapy program on gait and functionality in chronic stroke: A case study
2021, Fisioterapia
Describir, mediante pruebas funcionales y biomecánicas, cómo la intervención personalizada de fisioterapia acuática puede contribuir a mejorar la marcha y funcionalidad en un paciente con accidente cerebrovascular crónico.
Mujer de 63 años que experimentó un accidente cerebrovascular en 2006. Presentaba hemiplejía del miembro superior izquierdo y hemiparesia del miembro inferior izquierdo, que limitaban su marcha y funcionalidad. Se evaluaron la fuerza muscular isométrica, la percepción del esfuerzo para actividades de la vida diaria, la marcha mediante pruebas funcionales y el centro de presiones, utilizando una plataforma de fuerzas.
Dos sesiones de terapia acuática a la semana, durante 8 semanas, basadas en la terapia acuática específica Halliwick ®, el método de los anillos de Bad Ragaz ® y en entrenamiento de marcha con peso y dobles tareas.
La percepción del esfuerzo al caminar disminuyó 30 mm, la prueba Timed Up and Go disminuyó 5,88 segundos, la fuerza muscular aumentó más de 4 kg en todos los músculos, excepto flexores de cadera y extensores de rodilla, y el desplazamiento del centro de presiones disminuyó en todos los planos y tareas evaluadas.
Este estudio respalda la idea de que la terapia acuática puede contribuir a mejorar aspectos biomecánicos que ayudan a explicar las mejoras clínicas en pacientes con accidente cerebrovascular.
To describe, through functional and biomechanical tests, how a personalized aquatic physiotherapy intervention can contribute to improving gait and functionality in a patient with chronic stroke.
Woman with 63-year-old who suffered a stroke in 2006. She presents hemiplegia of the left upper limb and hemiparesis of the left lower limb, which limit her gait and functionality. Isometric muscle strength, perception of effort for activities of daily living, gait through functional tests, and center of pressure displacement were evaluated using a force platform.
Two aquatic therapy sessions per week, for 8 weeks, based on Specific Aquatic Therapy-Halliwick ®, Bad Ragaz ® Ring Method and dual task weight gait training.
Perception of effort when walking decreased 30 mm, Timed-Up-and-Go decreased by 5.88 seconds, muscle strength increased more than 4 kg in all muscles, except hip flexors and knee extensors, and center of pressure displacement decreased in all the plans and tasks evaluated.
This study supports the idea that aquatic therapy can contribute to improving biomechanical aspects that can have an impact on clinical improvements in stroke patients.
Postural organization and inter-limb coordination are altered after stroke when an isometric maximum bilateral pushing effort of the upper limbs is performed
2021, Clinical Biomechanics
Postural strategies of the trunk and the lower limbs are linked to upper limb motor activities. The objective was to analyze the postural organization at the lower limbs as well as the inter-limb coordination during isometric maximal bilateral pushing of upper limbs.
Fifteen individuals after stroke and 17 healthy participants were assessed with an instrumented exerciser paired with an instrumented sitting surface while they executed isometric bilateral pushes with the upper limbs. The anteroposterior, vertical and mediolateral forces were recorded at the handles, the thighs and the feet. Force values at maximal bilateral pushing efforts at each segment and inter-limb coordination between sides were compared.
During the isometric pushes, the paretic maximal forces at the handles for stroke participants were lower than the nonparetic side and lower than both sides of the control participants (p < 0.036). The control and stroke participants had moderate to good coordination for the anteroposterior forces (hands and thighs). While they used similar postural strategies to the controls except for a decreased weight on the paretic foot, vertical forces were less coordinated at the handles and feet in the stroke group (p < 0.050). The inter-trial variability was also higher in the stroke group.
Bilateral pushing with gradual efforts induces impaired postural strategies and coordination between limbs in individuals after stroke. It may reveal to be a promising strategy to assess and train post-stroke individuals in a clinical setting. Also, providing feedback would help better control symmetry during efforts.

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^☆: Supported by National Science Council, Taiwan, grant NSC85-2331-B-182A-023.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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ArticleThe sit-to-stand movement in stroke patients and its correlation with falling☆,☆☆

Abstract

Clin Biomech

Arch Phys Med Rehabil

J Biomech

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Epidemiology of falls among patients in a rehabilitation hospital

Arch Phys Med Rehabil

Predicting falls among patients in a rehabilitation hospital

Am J Phys Med Rehabil

Patient falls in stroke rehabilitation

Falls in the elderly related to postural imbalance

BMJ

Balance function in elderly people who have and who have not fallen

Arch Phys Med Rehabil

Article
The sit-to-stand movement in stroke patients and its correlation with falling☆,☆☆