Several limitations may result from the present study design. First, the present study results cannot be extrapolated to all people with stroke, particularly patients at lower functional levels with walking disability or severe cognitive impairments. Second, the subjects were not separated into a construction data set and a validation data set to test the multivariate logistic regression function because of the small number of subjects enrolled.
Figure 2-4 Balance and gait training for a stroke patient.
Figure 2-5 Dynamic balance testing and training.
Figure 2-6 A protable gait analysis instruments.
Figure 2-7 Results of balance and gait Analysis.
Conclusions
Multiple factors determine the risk of a fall in stroke patients, and a comprehensive assessment is needed to better understand the complex correlation between motor impairment, psychological factors, and the risk of falls in stroke patients.
The results of the present study revealed that the degree of depression, in addition to gait asymmetry and ankle spasticity, may play a crucial role in predicting a fall in stroke subjects. Therefore, more attention should be paid to emotional and social consequences in stroke patients in addition to regular intervention to improve physical function. The predictive factors determined in the present study provide additional prevention strategies for the healthcare team to prevent future falls in stroke patients after they return home.
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Postural influence on Stand-to-Sit leg load sharing strategies and sitting impact forces in stroke patients
Introduction
Sit-to-Stand (SitTS) and Stand-to-Sit (StandTS) are both considered essential activities in everyone’s daily life [1, 2]. Many studies have investigated the
characteristics of SitTS in healthy subjects [3–13], elderly people [11–14], and stroke patients [2–7,13,15–20], but fewer are focused on StandTS [2,3,10–12,15,16].
Although StandTS seems like a reverse movement of SitTS, the sitting impact accounts for the inherit difference. Unlike heel strike during gait, sitting impact cannot be diminished by the active and passive damping components of lower
extremities. Thus, for stroke patients, excessive impact caused by poor modulation of body descending velocity may result in a damaging load to spine. Further, the
instantaneous instability at impact moment coupled with the position changes of StandTS [1,3,12] increases the risk of falls. Despite the clinical significance, we could find no research published investigating the sitting impact in stroke patients.
Following stroke, patients often present asymmetrical leg load due to abnormal muscle synergy and muscle weakness during their functional activities such as standing [17,21], SitTS [2–7,15–17,20], and StandTS [2,3,15,16]. The clinical
significance of asymmetrical leg load during StandTS in connection to sitting
impact was not reported. In stroke rehabilitation, training paretic legs in muscle coordination and strength is an important goal [16, 20, 24–26] since it can prevent the overuse of the non-paretic side through reduced leg load asymmetry. Also, when patients perform daily living activities in various situations where safety
considerations are top priority, the use of the non-paretic leg becomes a desirable strategy since the function of the paretic side is limited.
Previous studies have shown that altering the leg placement significantly affects the leg load of stroke patients for SitTS and/or StandTS [5, 6,15, 16]. The main finding was that placing paretic legs posterior improves asymmetry of vertical
reaction forces or knee extensor moment between two sides. This evidence thus suggests that adopting different postural configurations alters the leg load sharing
strategy used to accomplish various functional tasks for stroke patients. In addition to the leg placement, a specific arm placement was suggested by neurodevelopmental
techniques (NDT) in order to facilitate symmetrical movements for stroke patients [18,22,23]. Similarly, another study demonstrated that arm movements affect the force production in lower limbs [9]. However, to our knowledge, the influence of various combinations of arm and leg placements on leg load sharing strategy during
functional tasks has not been investigated.
The purpose of this study was, therefore, to investigate leg load sharing strategies
and sitting impact forces in stroke patients during StandTS movement during different postural configurations. The hypothesis was that adopting different arm placements,
combined with leg placements, would alter the leg load sharing strategy of sitting down while performing StandTS and influence the subsequent sitting impact. Four configurations of arm and leg placements were evaluated on leg load sharing
strategies and sitting impact forces, respectively. This research could provide useful information for clinicians involved in exercise design for stroke patients with a view to take sitting impact into account as a safety requirement during rehabilitation.
Methods