The Crucial Changes of Sit-to-Stand Phases in Subacute Stroke Survivors Identified by Movement Decomposition Analysis.

Yu Rong Mao,Ling Chen,Le Li,Wai Leung Ambrose Lo,Zhi Qin Xu,Dong Feng Huang,Xiu Qin Wu,Jiang Li Zhao,Ming Hui Ding,Rui Hao Bian

doi:10.3389/fneur.2018.00185

Abstract

The aim of this study was to detect the key changes during sit-to-stand (STS) movement cycle in hemiparetic stroke survivors using a five-phase kinematic and kinetic analysis. Twenty-five subacute stroke survivors and 17 age-matched healthy adults participated in this study. The kinematic and kinetic parameters during STS cycle were measured using three-dimensional motion analysis system with force plates. The five standard phases of STS cycle were identified by six timing transitional points. Longer total time as well as larger changes were observed at the initial phase (phase I, 0.76 ± 0.62 VS 0.43 ± 0.09 s; p = 0.049) and at the end of hip and knee extension phase (phase IV, 0.93 ± 0.41 VS 0.63 ± 0.14 s; p = 0.008) in the stroke group than healthy group. Time to maximal knee joint moment was significantly delayed in the stroke group than in the control group (1.14 ± 1.06 VS 0.60 ± 0.09 s, p < 0.001). The maximal hip flexion was lower during the rising phase from seated position on the affected side in the stroke group than in the control group (84.22° ± 11.64°VS 94.11° ± 9.40°; p = 0.022). Ground reaction force was lower (4.61 ± 0.73 VS 5.85 ± 0.53 N, p < 0.001) in the affected side of the stroke group than in the control group. In addition, knee joint flexion was significantly lower at just-standing phase (T4) and at end point (T5) (5.12° ± 5.25° VS 8.21° ± 7.28°, p = 0.039; 0.03° ± 5.41° VS 3.07° ± 6.71°, p = 0.042) on the affected side than the unaffected side. Crucial decrease of knee joint moment at abrupt transitory (T2) and the maximal moment was also observed on the affected side in comparison with the unaffected side (0.39 ± 0.29 VS 0.77 ± 0.25 Nm/kg, p < 0.001; 0.42 ± 0.38 VS 0.82 ± 0.24 Nm/kg, p < 0.001). The findings of movement decomposition analysis provided useful information to clinical evaluation of STS performance, and may potentially contribute to the design of rehabilitation intervention program for optimum functional recovery of STS after stroke.

Highlights

The ability to stand up from a seated position is very important in performing activities of daily living independently
This study aimed to explore the kinematic and kinetic characteristics of STS based on phases and transitional points analysis in bilateral lower limbs of subacute stroke survivors, and to compare the characteristic changes with healthy adults
The increased total time of the STS task caused by lower speed indicates rising from a seated position is a challenging activity for subacute stroke survivors

Summary

Introduction

The ability to stand up from a seated position is very important in performing activities of daily living independently. It is a prerequisite for gait [1, 2]. Stroke survivors suffer from impaired mobility and walking ability [7, 8] and these common symptoms contribute to STS disability that further confines their activities of daily life [9]. Stroke survivors are prone to fall during STS because of the reduced ability of standing up from a chair [10]. It is necessary to have an improved understanding on STS characteristics during the action implementation to improve training task performance and to decrease the fall rate in hemiparetic stroke survivors [14]

Methods

Results

Conclusion