Gait turning patterns in chronic ischemic stroke males and its relationship to recovery

Abstract

Introduction:Impaired turning patterns have been considered as 1 factor which potentially leads to disability in chronic stroke patients. Mobility comprises 80% of the chief disability, and would eventually lead to falls. Expanded Timed Up and Go (ETUG) is an effective mobility assessment method. It utilizes video recording to analyze the conventional Time Up and Go (TUG) Test components, which includes turning pattern analysis.Methods:Six healthy males without stroke history and 21 chronic ischemic stroke males (divided into subjects with or without the presence of flexor synergy pattern subgroups) capable of independent ambulation were recruited from Neurology and Medical Rehabilitation Department outpatient clinic. ETUG tests were recorded for each subject and were analyzed thoroughly using a computer program.Results:Timed Up and Go time was significantly different between the 3 groups (P = .001). As compared to control, and synergy absent group, median turning time was highest in chronic stroke patients with presence of flexor synergy by 2786 ms (P = .002), but was not significantly different in percentage ETUG (14%, P = .939). Further analysis revealed that Brunnstrom stage and number of steps taken for turning significantly affect TUG duration. Other factors such as hemiparetic side, or body height were not significantly associated.Discussion:The presence of flexor synergy would significantly affect turning time, this would then correlate to the disability of shifting body's center of gravity, as a part of the Stroke core set of International Classification of Functioning, Disability, and Health (ICF).Therefore, stroke patients need to have early ambulatory training regarding pivoting motion rather than solely focusing on straight walking. Instead of hemiparetic side, it is possible that overall turning time is affected by coordination and orientation capability, signifying the importance of cortical plasticity.

The Validity and Reliability of Six Minute Walk Test in a 15 Meter Track

“…The three-step turn is made to avoid the occurrence of overly wide rotation, and does not utilize pivoting, which was generally adapted in stroke patients with weaker balance on one side. 10 It was previously shown that unstable turn might follow up to unstable gait, being unable to walk in a straight line as the subject tries to restore their balance following the pivot turn. 9,10 In an extensive observation of turns, it was shown that young subjects with no difficulty of turning that none would initiate their turn with forward leaning, it would either be vertically aligned trunk and hip, slight backward lean, or initiated by lower extremity before being followed up by trunk.…”

“…10 It was previously shown that unstable turn might follow up to unstable gait, being unable to walk in a straight line as the subject tries to restore their balance following the pivot turn. 9,10 In an extensive observation of turns, it was shown that young subjects with no difficulty of turning that none would initiate their turn with forward leaning, it would either be vertically aligned trunk and hip, slight backward lean, or initiated by lower extremity before being followed up by trunk. 9 The three steps turning method effectively adapt this physiologic trajectory of turning, hence reflecting adequate motor control, and leading to better quality of life.…”

“…9 It was shown in a cross sectional observation of age matched stroke patients, gait turning patterns change significantly. 10 This would mean that the turning method itself must be observed in determining shorter length than 30 meter, as instability tends to add longer time in turning and thus reduces total distance. 11,12 Shorter course length have been shown to significantly reduce walking distance by up to 100 meter, this will cause inaccurate predictions due to the additional turns taken.…”

International Classification of Functioning, Health and Disability (ICF) Conceptual Approach towards Spinocerebellar Ataxia

“…However in cases of SCA, probably the complete TUG test might not always be performable due to high risk of fall. Several studies had also utilized expanded TUG test, which divides the full TUG test into segments measured by milliseconds, namely sit to stand, gait 1, turning, gait 2, and stand to sit [48,49]. By separating these components, physiatrists would have a better view on which component are hindering the subject in achieving good TUG performance, and at the same time, would be able to assess improvements more accurately.…”

“…By separating these components, physiatrists would have a better view on which component are hindering the subject in achieving good TUG performance, and at the same time, would be able to assess improvements more accurately. Although the expanded TUG have not been utilized in SCA studies, it has been commonly used in other chronic neurological cases such as stroke, and hence should be recommended for future studies on degenerative ataxia [48].…”