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      Correlation between balance and gait according to pelvic displacement in stroke patients

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          Abstract

          [Purpose] The purpose of this study was to investigate the correlations of balance and gait according to pelvic displacement in stroke patients. [Subjects] The subjects of this study were 58 stroke patients who had been admitted to a hospital. [Methods] A Global Postural System was used to measure pelvic displacement. To measure the balance ability, a Tetrax balance system was used to measure the weight distribution index and stability index. Gait ability was measured during the 10-Meter Walking Test and Figure-of-8 Walk Test. [Results] The results of this study showed that was significant positive correlation between the anterior superior iliac spine height difference in pelvic displacement and the weight distribution index and significant positive correlation between the posterior superior iliac spine height difference and the stability index in the normal position with the eyes closed. Statistically significant positive correlation also was found between the anterior superior iliac spine height difference and the straight and curved gait ability. [Conclusion] The increased pelvic displacement in stroke patients results in a decrease in balance ability and gait speed. This suggests that control of pelvic displacement is necessary before functional training for patients with stroke.

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          Most cited references17

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          Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.

          To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke. Descriptive analysis of convenience sample. Outpatient rehabilitation clinic of a hospital in Taiwan. Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device. Not applicable. Subjects' maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GaitMatII. Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R(2)=.57, R(2)=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R(2)=.76 for temporal asymmetry; R(2)=.46 for spatial asymmetry) and fast-speed (R(2)=.75 for temporal asymmetry; R(2)=.45 for spatial asymmetry) walking. Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments.
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            High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors.

            To evaluate the efficacy of supervised high-intensity progressive resistance training (PRT) on lower extremity strength, function, and disability in older, long-term stroke survivors. Forty-two volunteers aged 50 years and above, 6 months to 6 years after a single mild to moderate stroke, were randomized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press (LP), unilateral paretic and nonparetic knee extension (KE), ankle dorsiflexion (DF), and plantarflexion (PF) exercises. Functional performance was assessed using the 6-minute walk, stair-climb time, repeated chair-rise time, and habitual and maximal gait velocities. Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument (LLFDI). Single-repetition maximum strength significantly improved in the PRT group for LP (16.2%), paretic KE (31.4%), and nonparetic KE (38.2%) with no change in the control group. Paretic ankle DF (66.7% versus -24.0%), paretic ankle PF (35.5% versus -20.3%), and nonparetic ankle PF (14.7% versus -13.8%) significantly improved in the PRT group compared with the control. The PRT group showed significant improvement in self-reported function and disability with no change in the control. There was no significant difference between groups for any performance-based measure of function. High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke, and results in reductions in functional limitations and disability.
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              Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test.

              The Figure-of-8 Walk Test (F8W) involves straight and curved paths and was designed to represent walking skill in everyday life. The purposes of this study were to validate the measure in older adults with walking difficulties and to explore correlates of the curved-path walking measure not represented by a straight-path walking measure. Fifty-one community-dwelling older adults with mobility disability participated in 2 baseline visits as part of an intervention study. The F8W time, steps, and smoothness and measures of gait (gait speed, modified Gait Abnormality Rating Scale [GARS-M]), physical function (Late Life Function and Disabilities Index [LLFDI], Survey of Activities and Fear of Falling in the Elderly [SAFFE], Gait Efficacy Scale [GES], Physical Performance Test [PPT], and fall history), and movement control and planning (gait variability, Trail Making Test B [Trails B]) were recorded in each test session. Bivariate correlations for the F8W with each variable were conducted to examine concurrent and construct validity. Adjusted linear regression analyses were performed to explore the variance in mobility explained by F8W independent of gait speed. Figure-of-8 Walk Test time correlated with gait (gait speed, r=-.570; GARS-M, r=.281), physical function (LLFDI function, r=-.469; SAFFE restriction subscale, r=.370; PPT, r=-.353), confidence in walking (GES, r=-.468), and movement control (step length coefficient of variation, r=.279; step width coefficient of variation, r=-.277; Trails B, r=.351). Figure-of-8 Walk Test steps correlated with step width variability (r=-.339) and was related to fear of falling (t=-2.50). All correlations were significant (P<.05). This pilot study had a small sample size, and further research is needed. The F8W is a valid measure of walking skill among older adults with mobility disability and may provide information complementary to gait speed.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                22 July 2015
                July 2015
                : 27
                : 7
                : 2171-2174
                Affiliations
                [1) ] Department of Physical Therapy, Saemirae Hospital, Republic of Korea
                [2) ] Department of Physical Therapy, Kwangju Women’s University, Republic of Korea
                [3) ] Department of Occupational Therapy, Howon University, Republic of Korea
                Author notes
                [* ]Corresponding author. Jin Young Kim, Department of Occupational Therapy, Howon University: 64 Howondae 3-gil, Impimyeon, Gunsan-si 573-932, Republic of Korea. (E-mail: specialkjy@ 123456gmail.com )
                Article
                jpts-2015-157
                10.1589/jpts.27.2171
                4540843
                a1863723-2590-4185-9f64-8da9dac116ba
                2015©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 25 February 2015
                : 03 April 2015
                Categories
                Original Article

                balance,pelvic displacement,stroke
                balance, pelvic displacement, stroke

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