The Relationship of Trunk Control with Lower Extremity Sense, Balance, and Walking in Individuals with Stroke

Year 2023, Volume: 13 Issue: 3, 530 - 536, 11.09.2023

Zehra Ekmekçioğlu , Zekiye İpek Katırcı Kırmacı , Nevin Ergun

https://doi.org/10.33808/clinexphealthsci.1094360

Cited By: 1

Abstract

Objective: This study was conducted to investigate the relationship between trunk control and lower extremity sense, balance and gait in stroke individuals.
Methods: Thirty subacute and chronic stroke patients were included in the study (mean age 52. 2 14.4 years). Trunk Impairment Scale (TIS) and Turkish version of Postural Assessment Scale for Stroke Patients (PASS-T) was used for evaluating the body control, and Tinetti Balance Test (TBT) was used for evaluating balance. Tinetti Gait Test (TGT) and Ten Meter Walking Test (TMWT) were applied for evaluating walking. The light touch sense and proprioception, Fugl-Meyer Assessment of Sensorimotor Function (FMASF) for lower extremity were used. Furthermore, neglect, plantar pressure sense and stereognosis for lower extremity were evaluated.
Results: There was a significant positively strong correlation between TIS and TBT, TGT and FMSMFT, and negatively strong correlation between TIS and TMWT (p<0.05). There was a significant positively strong correlation between PASS-T and TBT, TGT and FMSMFT, negatively strong correlation between TMWT (p<0.05). TIS, PASS-T, TBT and TGT values were found significantly high in the presence of plantar pressure sense and stereognosis; and significantly low in the presence of neglect (p<0.05).
Conclusion: Trunk control is related with lower extremity sense and affects balance and walking.

Keywords

Stroke, postural balance, lower extremity, sensation, walking

References

• Bakar C, Oymak S, Maral I. Turkey’s epidemiological and demographic transitions: 1931-2013. Balkan Med J. 2017;34(4):323-334. DOI: 10.4274/balkanmedj.2016.0960
• Hankey GJ. Stroke: How large a public health problem, and how can the neurologist help? Arch Neurol. 1999;56(6):748-754. DOI: 10.1001/archneur.56.6.748
• Karthikbabu S, Chakrapani M, Ganeshan S, Rakshith KC, Nafeez S, Prem V. A review on assessment and treatment of the trunk in stroke: A need or luxury. Neural Regen Res. 2012;7(25):1974–1977. DOI: 10.3969/j.issn.1673-5374.2012.25.008
• Lynch EA, Hillier SL, Stiller K, Campanella RR, Fisher PH. Sensory retraining of the lower limb after acute stroke: A randomized controlled pilot trial. Arch Phys Med Rehabil. 2007;88(9):1101-1107. DOI: 10.1016/j.apmr.2007.06.010
• Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003;84(11):1692-1702. DOI: 10.1053/s0003-9993(03)00277-6
• Mattingley JB, Driver J, Beschin N, Robertson IH. Attentional competition between modalities: extinction between touch and vision after right hemisphere damage. Neuropsychologia 1997;5(6):867-880. DOI: 10.1016/s0028-3932(97)00008-0
• Riddoch MJ, Humphreys GW, Bateman A. Stroke: stroke issues in recovery and rehabilitation. Physiotherapy 1995;81(11):689-694. DOI: 10.1016/S0031-9406(05)66623-0
• Vaishnavi S, Calhoun J, Chatterjee A. Crossmodal and sensorimotor integration in tactile awareness. Neurology 1999;53(7):1596-1596. DOI: 10.1212/wnl.53.7.1596
• Morioka S, Yagi F. Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: A randomized controlled pilot trial. Clin Rehabil. 2003;17(6):600-607. DOI: 10.1191/0269215503cr654oa
• Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review. Neurol Neurochir Pol. 2017;51(1):92-100. DOI: 10.1016/j.pjnns.2016.11.003
• Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: A new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-334. DOI: 10.1191/0269215504cr733oa
• Sag S, Buyukavci R, Sahin F, Sag MS, Dogu B, Kuran B. Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients. North Clin Istanb. 2018;6(2):156–165. DOI: 10.14744/nci.2018.01069
• Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: The Postural Assessment Scale for Stroke Patients (PASS). Stroke 1999:30(9);1862-1868. DOI: 10.1161/01.str.30.9.1862
• Zöngür S, Aksoy CC, Taşpınar F, Taşpınar B, Kenar B. Validity and reliability of the postural assesment scale for stroke patients of Turkish version. IDUHeS. 2018;1(2):23-35.
• Canbek J, Fulk G, Nof L, Echternach J. Test-retest reliability and construct validity of the tinetti performance-oriented mobility assessment in people with stroke. J Neurol Phys Ther. 2013;37(1):14-19. DOI: 10.1097/NPT.0b013e318283ffcc
• Ağırcan D. Validity and reliability of Turkish version of tinetti balance and gait assessment (Master Thesis). Pamukkale University Institute of Health Sciences, Denizli. 2009.
• Cheng DK, Nelson M, Brooks D, Salbach NM. Validation of stroke-specific protocols for the 10-meter walk test and 6-minute walk test conducted using 15-meter and 30-meter walkways. Top Stroke Rehabil. 2020;27(4):251-261. DOI: 10.1080/10749357.2019.1691815
• Lin JH, Hsueh IP, Sheu CF, Hsieh CL. Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients. Clin Rehabil. 2004;18(4):391-397. DOI: 10.1191/0269215504cr737oa
• Tavaszi I, Nagy AS, Szabo G, Fazekas G. Neglect syndrome in post-stroke conditions: Assessment and treatment (scoping review). Int J Rehabil Res. 2021;44(1):3-14. DOI: 10.1097/MRR.0000000000000438
• Verheyden G, Vereeck L, Truijen S, Troch M, Herregodts I, Lafosse C, De Weerdt W. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil. 2006;20(5):451-458. DOI: 10.1191/0269215505cr955oa
• Fujimoto H, Mihara M, Hattori N, Hatakenaka M, Kawano T, Yagura H, Mochizuki H. Cortical changes underlying balance recovery in patients with hemiplegic stroke. Neuroimage. 2014; 85:547-554. DOI: 10.1016/j.neuroimage.2013.05.014
• Lin YH, Tang PF, Wang YH, Eng JJ, Lin KC, Lu L, Chen SC. Reactive postural control deficits in patients with posterior parietal cortex lesions after stroke and the influence of auditory cueing. Am J Phys Med Rehabil. 2014;93(10):849-859. DOI: 10.1097/PHM.0000000000000093
• Çekök K, Şimşek TT. The effect of Nintendo Wii games on balance and upper extremity functions in patients with stroke. Turk J Physiother Rehabil. 2016;27(2):61-71 (Turkish)
• Sommerfeld DK, Von Arbin MH. The impact of somatosensory function on activity performance and length of hospital stay in geriatric patients with stroke. Clin Rehabil. 2004;18(2):149-155. DOI: 10.1191/0269215504cr710oa
• Sullivan JE, Hedman LD. Sensory dysfunction following stroke: Incidence, significance, examination, and intervention. Top Stroke Rehabil. 2008;15(3):200-217. DOI: 10.1310/tsr1503-200
• Huzmeli ED, Yildirim SA, Kilinc M. Effect of sensory training of the posterior thigh on trunk control and upper extremity functions in stroke patients. Neurol Sci. 2017;38(4):651-657. DOI: 10.1007/s10072-017-2822-z
• Kars H, Hijmans JM, Geertzen JH, Zijlstra W. The effect of reduced somatosensation on standing balance: A systematic review. J Diabetes Sci Technol. 2009;3(4):931-943. DOI: 10.1177/193229680900300441
• Kafa N, Citaker S, Tuna Z, Guney H, Kaya D, Guzel NA, Yetkin I. Is plantar foot sensation associated with standing balance in type 2 diabetes mellitus patients. Int J Diabetes Dev C. 2015;35(3):405-410. DOI:10.1007/s13410-015-0396-y
• Carr J, Shepherd R. The changing face of neurological rehabilitation. Braz J Phys Ther. 2006;10(2):147-156. DOI:10.1590/S1413-35552006000200003
• Goldberg A, Hernandez ME, Alexander NB. Trunk repositioning errors are increased in balance-impaired older adults. J Gerontol A Biol Sci Med Sci. 2005;60(10): 1310-1314. DOI: 10.1093/gerona/60.10.1310
• Karthikbabu S, John MS, Manikandan N, Bhamini KR, Chakrapani M, Akshatha N. Role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke: A pre-post design. Neurosci Med. 2011; 2:61-67. DOI: 10.4236/nm.2011.22009
• Ryerson S, Byl NN, Brown DA, Wong RA, Hidler JM. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008;32(1):14-20. DOI: 10.1097/NPT.0b013e3181660f0c
• Goljar N, Rudolf M, Bizovicar N. Algorithm for selection of balance assessment tools in post-stroke patients. Int J Rehabil Res. 2019;42(3):229-233. DOI: 10.1097/MRR.0000000000000360
• Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke 2002;33(11): 2626-2630. DOI: 10.1161/01.str.0000033930.05931.93
• Hsueh IP, Chen JH, Wang CH, Chen CT, Sheu CF, Wang WC, Hsieh CL. Development of a computerized adaptive test for assessing balance function in patients with stroke. Phys Ther. 2010;90(9):1336-1344. DOI: 10.2522/ptj.20090395
• Donovan K, Lord SE, McNaughton HK, Weatherall M. Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors. Clin Rehabil. 2008;22(6):556-563. DOI: 10.1177/0269215507085378
• Lin PY, Yang YR, Cheng SJ, Wang RY. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568. DOI: 10.1016/j.apmr.2005.12.042
• Goldie PA, Matyas TA, Evans OM. Gait after stroke: initial deficit and changes in temporal patterns for each gait phase. Arch Phys Med Rehabil. 2001;82(8):1057-1065. DOI: 10.1053/apmr.2001.25085
• Hill K, Ellis P, Bernhardt J, Maggs P, Hull S. Balance and mobility outcomes for stroke patients: a comprehensive audit. Aust J Physiother. 1997;43(3):173-180. DOI: 10.1016/s0004-9514(14)60408-6
• Kim JH, Lee SM, Jeon SH. Correlations among trunk impairment, functional performance, and muscle activity during forward reaching tasks in patients with chronic stroke. J Pysical Ther Sci. 2015;27(9):2955-2958. DOI: 10.1589/jpts.27.2955
• Isho T, Usuda S. Association of trunk control with mobility performance and accelerometry-based gait characteristics in hemiparetic patients with subacute stroke. Gait Posture 2016;44:89-93. DOI: 10.1016/j.gaitpost.2015.11.011
• Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Van de Heyning P. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil Neural Repair 2012;26(3):231-238. DOI: 10.1177/1545968311416822