Abstract
Recent evidence indicates that turning difficulty may correlate with trunk control; however, surface electromyography has not been used to explore trunk muscle activity during turning after stroke. This study investigated trunk muscle activation patterns during standing turns in healthy controls (HCs) and patients with stroke with turning difficulty (TD) and no TD (NTD). The participants with stroke were divided into two groups according to the 180° turning duration and number of steps to determine the presence of TD. The activation patterns of the bilateral external oblique and erector spinae muscles of all the participants were recorded during 90° standing turns. A total of 14 HCs, 14 patients with TD, and 14 patients with NTD were recruited. The duration and number of steps in the turning of the TD group were greater than those of the HCs, independent of the turning direction. However, the NTD group had a significantly longer turning duration than did the HC group only toward the paretic side. Their performance was similar when turning toward the non-paretic side; this result is consistent with electromyographic findings. Both TD and NTD groups demonstrated increased amplitudes of trunk muscles compared with the HC groups. Their trunk muscles failed to maintain consistent amplitudes during the entire movement of standing turns in the direction that they required more time or steps to turn toward (i.e., turning in either direction for the TD group and turning toward the paretic side for the NTD group). Patients with stroke had augmented activation of trunk muscles during turning. When patients with TD turned toward either direction and when patients with NTD turned toward the paretic side, the flexible adaptations and selective actions of trunk muscles observed in the HCs were absent. Such distinct activation patterns during turning may contribute to poor turning performance and elevate the risk of falling. Our findings provide insights into the contribution and importance of trunk muscles during turning and the association with TD after stroke. These findings may help guide the development of more effective rehabilitation therapies that target specific muscles for those with TD.
Highlights
More than 40% of walking involves turning in daily life [1]; turning frequently results in falls for patients with stroke [2]
The turning difficulty (TD) stroke group exhibited a significantly longer duration and more number of steps than did the no TD (NTD) stroke and healthy controls (HCs) groups when turning toward either side
The NTD group had a significantly longer turning duration toward the P side than did the HC group; the performance of the NTD group was similar to that of the HC group when turning toward the other side (Table 2)
Summary
More than 40% of walking involves turning in daily life [1]; turning frequently results in falls for patients with stroke [2]. Patients with stroke require more time and additional steps [3] to turn in place [4, 5] or while walking [3, 6] compared with healthy adults, indicating that these patients experience difficulty in turning after stroke. Our previous study indicated that turning toward the paretic side was associated with trunk flexion and rotation, trunk flexor strength, dynamic sitting balance, and trunk movement coordination [10]. These findings highlight the importance of trunk function in turning performance and suggest that trunk instability contributes to the TD in individuals with stroke
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