Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke

Abstract

Background: The pelvis is not stable after stroke, and poor trunk recovery might be the foremost contributor to altered pelvic alignment in sitting, standing and during walking. Aim: To analyze the relationship between pelvic alignment in standing and trunk control after stroke, and also test how these correlations are related to Brunnstrom's lower limb motor recovery. Methods: In the present cross-sectional study, 116 ambulant patients after stroke were assessed for their pelvic tilt angles in standing and trunk control using a palpation meter (PALM device) and the Trunk Impairment Scale (TIS), respectively. The pelvic tilt values were correlated to TIS scores by the Pearson's correlation coefficient. Results: The mean age, post-stroke duration, and Brunnstrom's lower limb motor recovery of study participants were 55 (13) years, 14.2 (11.3) months and 3.75 (0.79), respectively. The present study reported more lateral pelvic tilt of 2.47°( 1.78°) towards the most affected side and an anterior pelvic tilt of 4.4°(1.8°) bilaterally. The mean score of TIS was 10.4 (3). Pelvic tilt angles had a moderately inverse correlation with the total TIS score and coordination subscale of TIS (rvalue from -0.44 to -0.54), but a low inverse relationship to the dynamic sitting balance subscale of TIS (-0.36 to -0.45). Also, the pelvic tilt had a high negative correlation with trunk control (r-value from -0.68 to -0.84) in lower limb motor recovery stage 5. Conclusion: Pelvic alignment when standing is not normal after stroke, and this is influenced by poor trunk control and impairment of the lower extremities. Assessment of the pelvis provides further insight into planning the appropriate rehabilitation strategies in stroke.

Effects of Pelvic Stability Training on Movement Control, Hip Muscles Strength, Walking Speed and Daily Activities after Stroke: A Randomized Controlled Trial

“…These test positions were standardized and are showed in Appendix 2. The angle of lateral and anterior pelvic tilt in standing was measured using the palpation meter, a reliable device to measure pelvic instability in stroke [5, 7, 20]. The gait speed and cadence were calculated after a 10-m walk test [21].…”

“…In a recent cross-sectional study, it was observed that poor trunk control and lower extremity recovery are related to the pelvis instability in patients with chronic stroke [5]. Altered pelvic alignment in the standing position resulting from poor lower trunk control after stroke shall positively influence the balance, gait and functional performance [6].…”

Influence of pelvic inclination on sit to stand task in stroke patients

“…Tanaka and colleagues [28] stated that weakness of trunk muscles in hemiplegic patients resulted from the upper motor neuron lesion and disuse. In Anatomically, a part from the rectus abdominal muscle and the rest of the abdominal muscles are attached to the linea alba through central aponeurosis fascial expansions bilaterally [9]. During initiation of STS movement, the results of the present study showed a significant decrease of anterior pelvic tilt angle of both stroke groups compared with control.…”

“…Pelvic movements are also integrated in all functional activities [8]. After stroke, the patient's pelvis becomes unstable [9].…”

Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors

“…This was supported by the recent work in which the lateral tilt toward the most affected side and anterior pelvic tilt in standing were moderately correlated to trunk control, and these correlations were high in chronic stroke patients with better lower limb motor recovery. [15]…”