Sit-to-Stand in People with Stroke: Effect of Lower Limb Constraint-Induced Movement Strategies.

Charla Krystine Gray,Elsie Culham

doi:10.1155/2014/683681

Abstract

Background. Weight-bearing asymmetry and impaired balance may contribute to the increased fall risk in people with stroke when rising to stand from sitting. Objective. This study investigated the effect of constraint-induced movement (CIM) strategies on weight-bearing symmetry and balance during sit-to-stand in people with stroke. Methods. A nonrandom convenience sample of fifteen people with stroke performed the sit-to-stand task using three CIM strategies including a solid or compliant (foam) block strategy, with the unaffected limb placed on the block, and an asymmetrical foot position strategy, with the unaffected limb placed ahead of the affected limb. Duration of the task, affected limb weight-bearing, and centre of pressure and centre of mass displacement were measured in the frontal and sagittal plane. Results. Affected limb weight-bearing was increased and frontal plane centre of pressure and centre of mass moved toward the affected limb compared to baseline with all CIM strategies. Centre of mass displacement in the sagittal plane was greater with the compliant block and asymmetrical foot strategies. Conclusions. The CIM strategies demonstrated greater loading of the affected limb and movement of the centre of pressure and centre of mass toward the affected limb. The compliant block and asymmetrical foot conditions may challenge sagittal plane balance during sit-to-stand in people with stroke.

Highlights

People with stroke have a higher risk of falling compared with their age matched peers [1,2,3,4] with many falls occurring during transition movements including rising to stand from sitting [1, 5, 6]
STS in people with stroke is characterized by greater loading on the unaffected limb [6,7,8,9,10] and larger frontal plane centre of pressure (COP) displacement compared with age matched healthy adults [8, 10, 11]
Total sagittal plane center of mass (COM) displacement was greater with the compliant block and asymmetrical foot position conditions compared to baseline

Summary

Introduction

People with stroke have a higher risk of falling compared with their age matched peers [1,2,3,4] with many falls occurring during transition movements including rising to stand from sitting [1, 5, 6]. Constraint-induced movement (CIM) therapy is a treatment strategy designed to increase affected limb weightbearing during STS in people with stroke. Weight-bearing asymmetry and impaired balance may contribute to the increased fall risk in people with stroke when rising to stand from sitting. A nonrandom convenience sample of fifteen people with stroke performed the sit-to-stand task using three CIM strategies including a solid or compliant (foam) block strategy, with the unaffected limb placed on the block, and an asymmetrical foot position strategy, with the unaffected limb placed ahead of the affected limb. Duration of the task, affected limb weight-bearing, and centre of pressure and centre of mass displacement were measured in the frontal and sagittal plane. Affected limb weight-bearing was increased and frontal plane centre of pressure and centre of mass moved toward the affected limb compared to baseline with all CIM strategies. The compliant block and asymmetrical foot conditions may challenge sagittal plane balance during sit-to-stand in people with stroke

Objectives

Methods

Results

Discussion

Conclusion