The Crucial Changes of Sit-to-Stand Phases in Subacute Stroke Survivors Identified by Movement Decomposition Analysis

Abstract

ObjectiveThe aim of this study was to detect the key changes during sit-to-stand (STS) movement cycle in hemiparetic stroke survivors using a five-phase kinematic and kinetic analysis.MethodsTwenty-five subacute stroke survivors and 17 age-matched healthy adults participated in this study. The kinematic and kinetic parameters during STS cycle were measured using three-dimensional motion analysis system with force plates. The five standard phases of STS cycle were identified by six timing transitional points.ResultsLonger total time as well as larger changes were observed at the initial phase (phase I, 0.76 ± 0.62 VS 0.43 ± 0.09 s; p = 0.049) and at the end of hip and knee extension phase (phase IV, 0.93 ± 0.41 VS 0.63 ± 0.14 s; p = 0.008) in the stroke group than healthy group. Time to maximal knee joint moment was significantly delayed in the stroke group than in the control group (1.14 ± 1.06 VS 0.60 ± 0.09 s, p < 0.001). The maximal hip flexion was lower during the rising phase from seated position on the affected side in the stroke group than in the control group (84.22° ± 11.64°VS 94.11° ± 9.40°; p = 0.022). Ground reaction force was lower (4.61 ± 0.73 VS 5.85 ± 0.53 N, p < 0.001) in the affected side of the stroke group than in the control group. In addition, knee joint flexion was significantly lower at just-standing phase (T4) and at end point (T5) (5.12° ± 5.25° VS 8.21° ± 7.28°, p = 0.039; 0.03° ± 5.41° VS 3.07° ± 6.71°, p = 0.042) on the affected side than the unaffected side. Crucial decrease of knee joint moment at abrupt transitory (T2) and the maximal moment was also observed on the affected side in comparison with the unaffected side (0.39 ± 0.29 VS 0.77 ± 0.25 Nm/kg, p < 0.001; 0.42 ± 0.38 VS 0.82 ± 0.24 Nm/kg, p < 0.001).ConclusionThe findings of movement decomposition analysis provided useful information to clinical evaluation of STS performance, and may potentially contribute to the design of rehabilitation intervention program for optimum functional recovery of STS after stroke.

Investigating the Relationships Between Three Important Functional Tasks Early After Stroke: Movement Characteristics of Sit-To-Stand, Sit-To-Walk, and Walking

“…As the events of hesitation (maximum forward velocity and maximum upward acceleration) both occur around the end of Phase 1 of movement, the flexion momentum, these data indicate that hesitation is likely contributing factor to the longer Phase 1 of movement seen in STS compared to STW. A prolonged Phase 1 has previously been described in studies examining STW in stroke survivors when compared to healthy adults; here stroke survivors spent a greater amount in Phase 1 because of increased time spent in hip flexion (7). A lengthened Phase 1 of movement is also seen in older adults, when compared to younger adults attributed to an increased angle of trunk flexion (27).…”

“…(2) between 3 and 42 days after stroke, either infarct or hemorrhage; (3) considered to be fit for rehabilitation, having peripheral oxygen saturations 90%+ on air, resting pulse <101 beats/min; (4) able to take at least three steps with abnormal initial foot contact and/or decreased ability to take full body weight through the paretic lower limb during stance; with the assistance of up to two people if required; (5) able to follow a 1-stage command; and (6) free from contractures or loss of skin integrity in lower limb. (7) For inclusion in the secondary analysis presented here, participants were those who met the above criteria, 1-7, and who were: (8) able to complete a STS and STW task at the outcome measurement time point (∼6 weeks after start of the intervention phase) without physical assistance from another person, object or aid (e.g., walking stick).…”

“…Conversely, the associated functional task of sit-to-walk (STW) is a more complex, asymmetric activity that combines rising from sitting and gait initiation, via fluent movement transitions, to enable speed and efficiency of movement. Indeed, fluidity of STW could be seen as an expression of intact motor control and, like walking, this complex movement is challenging for people with motor deficit after stroke (7). As such, it is possible that STW may be associated with other important dynamic functions that require fluid movement between transitions, such as walking, and, in particular, walking that requires adaptation of parameters to meet environmental demands (8).…”

Older Adults with Weaker Muscle Strength Stand up from a Sitting Position with More Dynamic Trunk Use

“…In patients with a stroke, longer total time as well as changes at the initial phase and at the end of hip and knee extension phase were observed. The maximal hip flexion was lower during the rising phase from a seated position on the affected side in the stroke group [ 44 ]. Patients with end stage renal disease undergoing hemodialysis have high morbidity and mortality due to multiple causes.…”

Test–Retest Reliability of Functional Electromechanical Dynamometer on Five Sit-to-Stand Measures in Healthy Young Adults

“…The STS transition is regarded as one of the most demanding daily physical activities [ 8 ], associated with a high level of energy expenditure [ 9 ] and joint stress [ 10 ]. The STS performance can be adversely affected by multiple clinical conditions [ 11 , 12 ], such as aging [ 13 , 14 , 15 ]. It has been reported that people who have difficulty in reaching the bipedal position are more likely to fall [ 16 ].…”