The link between weight shift asymmetry and gait disturbances in chronic hemiparetic stroke patients

Szopa, Andrzej; Domagalska-Szopa, Małgorzata; Lasek–Bal, Anetta; Żak, Amadeusz

doi:10.2147/cia.s144795

Cited by 25 publications

(23 citation statements)

References 33 publications

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“…Previous studies have described a frequent nonefficient neuromuscular control of trunk stability and inaccurate trunk muscle recruitment patterns of control of the spinal load in relation to a given task and posture in these patients 3–5 . This is also associated with symptoms such as asymmetric posture, abnormal body imbalance, and deficit of weight transfer 6 …”

Section: Introductionmentioning

confidence: 94%

The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis

Cabrera‐Martos

Ortíz‐Rubio

Torres‐Sánchez

et al. 2020

PM&R

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Objective Patients with stroke frequently present postural control impairment. This review aimed to assess the effectiveness of core exercising on postural control in patients with stroke. Type Systematic review and meta‐analysis. Literature Survey Systematic review in the following databases: PubMed/MEDLINE, Web of Science, ScienceDirect, CINAHL, Scopus, and Physiotherapy Evidence Database (PEDro). Studies up to July 2019 were included. Methodology Studies were included if the sample was composed of adults with stroke, the intervention followed a core exercising approach (alone or combined with another intervention), and the study was a randomized controlled trial including at least one measurement related to posture control. Studies were independently screened for inclusion and data were extracted by two researchers, with a third researcher arbitrating any disputes. Study quality was assessed using the Downs and Black scale. Synthesis After screening of 1540 records, a total of 14 studies met the specified inclusion criteria and involved 520 participants. Two studies exhibited “excellent” quality and five exhibited “poor” quality. The meta‐analysis was performed with data from the Trunk Impairment Scale (mean difference 0.98; 95% confidence interval, 0.69 to 1.27; P < .001), Berg Balance Scale (mean difference 0.27; 95% confidence interval, −0.25 to 0.79; P = .317), and Timed Up and Go test (mean difference −0.09; 95% confidence interval, −0.49 to 0.31; P = .656). The results favored core exercising alone or in combination with proprioceptive neuromuscular facilitation when compared with conventional training or proprioceptive neuromuscular facilitation in patients with stroke. No significant differences in total values were found in the other measures. Conclusions The studies reviewed suggest that core exercising alone or in combination with other therapies had an impact on trunk performance when compared with conventional training in patients with stroke. However, total analyses did not show significant differences for the other measures related to balance ability analyzed.

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Section: Introductionmentioning

confidence: 94%

The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis

Cabrera‐Martos

Ortíz‐Rubio

Torres‐Sánchez

et al. 2020

PM&R

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“…Chengetanai et al in their study observed that as the asymmetry in weight distribution increases between the limbs, there was a decrease in scores of BBS with movement activities. This was attributed to an inability of the patients to transfer weight (weight shifts) onto either the limb which is very essential for smooth and efficient execution of activities of daily living involving balance and movement [18,30].…”

Section: Discussionmentioning

confidence: 99%

“…They observed a significant negative association between weight-bearing asymmetry, paretic step length, and walking speed. The probable explanation for these findings could be kinematic deviations in gait such as asymmetrical movement of the pelvis, inadequate paretic hip and knee flexion in swing phase, and excessive ankle plantar flexion that affect the spatiotemporal parameters [30]. Furthermore, Adegoke et al in a study evaluating asymmetry of weight bearing on the lower limbs and the association between PWBA and functional ambulation performance in ambulant stroke survivors found a strong correlation between the outcomes [18].…”

Section: Discussionmentioning

confidence: 99%

Influence of leg length discrepancy on balance and gait in post-stroke patients: a correlational study

Gardas

Shah

2020

Bull Fac Phys Ther

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Background A frequent complaint by stroke patients presenting for physiotherapy was perceived shortness of the affected lower limb and inability to weight bear onto the affected side. So, the present study aimed to evaluate influence of limb length discrepancy (LLD) on balance and gait parameters in patients with stroke. Subjects and methods Twenty participants were recruited based on the inclusion and exclusion criteria and were divided into two groups group A (LLD ≤ 1 cm) and group B (LLD > 1 cm). Postural sway was measured under wide base eyes open, wide base eyes closed, narrow base eyes open, and narrow base eyes closed conditions. Weight-bearing asymmetry and functional balance were assessed using the percentage body weight asymmetry and Berg balance scale. Also, step leg ratio and 10-M walk test was used to assess gait parameters. Results Intergroup comparison of postural sway exhibited a significant difference between groups in the AP direction in wide-based eyes open (WBEO), wide-based eyes closed (WBEC), narrow-based eyes open (NBEO), and narrow-based eyes closed (NBEC) conditions whereas only in NBEC condition in mediolateral direction; with group B (LLD > 1 cm) displaying a greater mean postural sway in all the conditions. The correlation of LLD with postural sway showed a significant positive correlation within AP direction under all the conditions and in WBEC and NBEC conditions in mediolateral direction. Intergroup comparison of step length ratio (SLR) showed a statistical difference between groups, and a negative correlation was found between LLD and SLR. A negative correlation was also seen between percentage weight-bearing asymmetry (PWBA) and speed as well as Berg’s balance scale (BBS), and a positive correlation was observed between BBS and speed. Conclusion Leg length discrepancy results in a significant decrease in balance control in the sagittal and frontal planes in patients with stroke. It also adds to the asymmetries in their gait. Therefore, LLD should be considered as a factor for balance and gait asymmetries in post-stroke patients.

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“…with dynamometers, pressure sensitive walkways or body worn accelerometers), allowing the disentanglement of the exact components responsible for mobility limitation. In contrast to most functional tests, these measures can also account for the asymmetry, which is typical for stroke patients [ 23 , 24 ]. Rehabilitative measures to restore LEPF in people after stroke include physical therapy, exercise (including training of balance, strength and gait), and the provision of adaptive devices [ 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol

et al. 2020

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Background Stroke is a major cause of disability and stroke incidence increases with age. Stroke frequently results in permanent limitations of mobility, and, consequently, the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcomes, detailed knowledge of the functional recovery process, regarding mobility, is needed. Objectives of the MOBITEC-Stroke study are: 1.) To characterize mobility, including lower extremity physical function (LEPF) and life space (the geospatial extent of all of a person’s movements), and changes in mobility within the first year after stroke. 2.) To identify and characterize subgroups with different mobility trajectories. 3.) To evaluate whether changes in LEPF are associated with changes in life-space. 4.) To evaluate participants’ reasons for going outdoors, transportation use, and assistance needed for outdoor movement. Methods Patients with incident first stroke who live in their own homes (target N = 59, based on sample size calculation) will be included in this cohort study. At 3, 6, 9, and 12 months after stroke a battery of mobility tests will be performed at the study centre, including laboratory-based tests of balance and strength, and quantitative gait analysis. Life-space assessment (including 1-week GPS measurements) will be performed in participants’ real life. Semantic information on visited locations (reasons for going outdoors, transportation use, assistance needed) will be collected by using interactive digital maps. Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for predefined subgroups. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories. Linear mixed effect models will be used to test whether changes in LEPF parameters are associated with changes in life-space. Participants’ motivation for going outdoors, transportation use, and assistance needed for outdoor mobility will be analysed descriptively. Discussion A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and adaptively tailored rehabilitation measures. Information about patients’ reasons for outdoor mobility will provide the opportunity to define individualized and patient-oriented rehabilitation goals. Trial registration ISRCTN85999967 (on 13 August 2020; retrospectively).

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The link between weight shift asymmetry and gait disturbances in chronic hemiparetic stroke patients

Cited by 25 publications

References 33 publications

The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis

The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis

Influence of leg length discrepancy on balance and gait in post-stroke patients: a correlational study

Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol

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