Balance analysis during the sit-to-stand movement of chronic hemiparetic individuals based upon their functional levels.
Pinheiro, Marina de Barros; Polese, Janaina Cunha; Machado, Gustavo de Carvalho; Scianni, Aline Alvim; Hirochi, Tânia Lúcia; Teixeira-Salmela, Luci Fuscaldi
Introduction: Balance deficits are frequently observed in individuals with hemiparesis and lead to disabilities in daily activities, such as the ability to walk. The sit-to-stand movement is essential for independent gait and balance is one of the main requirements for its performance. Objective: To analyse the balance parameters during the sit-to-stand movement in individuals with chronic hemiparesis, stratified according to the level of functional performance. Method: Individuals above 20 years of age with a time since the onset of the stroke of at least six months were divided into three functional groups, according to their walking speeds: Household ambulation (<0.4 m/s), limited community ambulation (0.4 to 0.8 m/s), and complete community ambulation (>0.8 m/s). The following balance parameters were assessed by the sit-to-stand test of the Balance Master System: (1) weight transfer time, (2) rising index and (3) the centre of gravity sway velocity. It was considered a significance level of α<0.05. Results: Eight-six individuals (56±13 years) participated. Statistically significant differences regarding weight transfer time were observed only between the household group and the others (limited community ambulation and complete community ambulation (F=4.42;p=0.01). Similarly, regarding the rising index, significant differences were observed only for the household ambulation group (F=8.46; p<0.01). Conclusion: Individuals with chronic hemiparesis, who had lower functional performance levels (household ambulation) spent more time to perform the sit-to-stand movement with less weight transfer to the lower limbs. These findings suggest that within clinical contexts when balance training is carried out to improve mobility and gait performance in individuals with household ambulation, parameters related to the transfer time and rising index should be emphasized.
1. Kelly-Hayes PM, Robertson JT, Broderick JP, Duncan PW, Hershey LA, Roth EJ, et al. The American Heart Association Stroke outcome classification. Stroke. 1998;29(6):1274-80.
2. Schmid AA, Van Puymbroeck M, Altenburger PA, Dierks TA, Miller KK, Damush TM, et al. Balance and balance selfefficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke. Arch Phys Med Rehabil. 2012;93(6):1101-7.
3. Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM, Women’s Health and Aging Study. Risk factors for falling in home-dwelling older women with stroke. Stroke. 2003;34(2):494–501.
4. Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC. Balance disability after stroke. Phys Ther. 2006;86(1):30-8.
5. Mazza C, Benvenuti F, Bimbi C, Stanhope SJ. Association between subject functional status, seat height, and movement strategy in sit-to-stand performance. J Am Geriatr Soc. 2004;52(10):1750-54.
6. Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005;86(8):1552-6.
7. Lee MY, Wong MK, Tang FT, Cheng PT, Lins PS. Comparison of balance responses and motor patterns during sitto-stand task with functional mobility in stroke patients. Am J Phys Med Rehabil. 1997;76(5):401-10.
8. Lee MY, Wong MK, Tang FT, Cheng PT, Chiou WK, Lins PS. New quantitative and qualitative measures on functional mobility prediction for stroke patients. J Med Eng Technol. 1998;22(1):14-24.
9. Janssen WG, Bussmann HB, Stam HJ. Determinants of the sit-to- stand movement: a review. Phys Ther. 2002;82(9):866-79.
10. Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61(3B):777-81.
11. Polese JC, Teixeira-Salmela LF, Nascimento LR, Faria CD, Kirkwood RN, Laurentino GC, et al. The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors. Clin Biomech. 2012;27(2):131–37.
12. Teixeira-Salmela LF, Silva PC, Lima RCM, Augusto ACC, Souza AC, Goulart F. Musculação e condicionamento aeróbico na performance funcional de hemiplégicos crônicos. Acta Fisiátrica. 2003;10(2):54-60.
13. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-89.
14. Rogind H, Christensen J, Danneskiold-Samsøe B, Bliddal H. Posturographic description of the regaining of postural stability following stroke. Clin Physiol Funct Imaging. 2005;25(1):1-9.
15. Srivastava A, Taly AB, Gupta A, Kumar S, Murali T. Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci. 2009;287(1-2):89-93.
16. Chien CW, Hu MH, Tang PF, Sheu CF, Hsieh CL. A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Arch Phys Med Rehabil. 2007;88(3):374-80.
17. Neurocom®International Inc. Balance Master Operators Manual. Version 7.0, Clackamas; 1999.
18. Chou SW, Wong AM, Leong CP, Hong WS, Tang FT, Lin TH. Postural control during sit-to stand and gait in stroke patients. Am J Phys Med Rehabil. 2003;82(1):42-7.
19. Boyne P, Israel S, Dunning K. Speed-dependent body weight supported sit-to-stand training in chronic stroke: a case series. J Neurol Phys Ther. 2011;35(4):178-84.
20. Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999;80(10):1211-18.
21. Polese JC, Pinheiro MB, Britto RR, Parreira VF, Teixeira-Salmela LF. Strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels. Braz J Phys Ther. 2013;17(5):487-93.
22. Mourey F, Pozzo T, Rouhier-Marcer I, Didier JP. A kinematic comparison between elderly and young subjects standing up from and sitting down in a chair. Age Ageing. 1998;27(2):137–46.
23. Mathiyakom W, McNitt-Gray JL, Requejo P, Costa K. Modifying center of mass trajectory during sit-to-stand tasks redistributes the mechanical demand across the lower extremity joints. Clin. Biomech., Bristol, 2005;20(1):105-111.
24. Roy G, Nadeau S, Gravel D, Malouin F, McFadyen BJ, Piotte F. The effect of foot position and chair height on the asymmetry of vertical forces during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis. Clin Biomech (Bristol, Avon) 2006;21(6):585-93.