Date Published: March 29, 2018
Author(s): Adnil W. Titus, Susan Hillier, Quinette A. Louw, Gakeemah Inglis-Jassiem.
Approximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated.
To describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics.
A total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p < 0.05). Participants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p < 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p < 0.001) and foot off (p < 0.049) in the coronal plane as well as at initial contact (p < 0.000) and foot off (p < 0.013) in the transverse plane. This pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke.
Stroke is a major global health concern in terms of mortality and chronic disability (Wissel et al. 2013). The global incidence of stroke is reported to account for approximately 5.5 million deaths annually and for 44 million disability-adjusted life-years lost (Mukherjee & Patil 2011). Hemiparesis is seen as the most common impairment after stroke and has a direct negative influence on the ability of a person to walk (Belda-Lois et al. 2011). Two out of three people experience persistent walking difficulties following a stroke (Stanhope et al. 2014). Walking difficulties in people with stroke are reported to be because of weakness (paresis) or abnormal tone of the limbs and trunk, impaired sensorimotor systems and central control mechanisms (Karthikbabu et al. 2011). The post-stroke gait pattern is characterised as hemiparetic with the predominant sensorimotor impairments being experienced in the contralesional upper and lower limbs. The role of the trunk in mobility and stability is however often overlooked as an integral component of performing daily core functions such as walking after stroke (Ryerson et al. 2008).
Ethical approval was granted by the Human Research Ethics Committee (HREC) of Stellenbosch University (reference number: S13/03/056) in July 2013 to conduct this observational descriptive study.
This study aimed to characterise key aspects of trunk motion during the full gait cycle of people with stroke using 3D kinematics for both the affected and unaffected sides. The secondary aims of the study included reporting of the spatiotemporal gait parameters of the sample.
The sample of this study were recruited from one setting, were a mixture of subacute and chronic, had received differing levels of rehabilitation experience and were all able to walk without the use of assistive devices. Therefore, the results of this study should not be generalised to the wider population of people with stroke and those with different or varying levels of function. This report focuses on the group data only, with an indication of individual variation provided by the standard deviations. It may be that with the expected heterogeneity in a stroke population, further individual analysis would yield more clinically meaningful information. Finally, the laboratory setting may have influenced the participants’ gait pattern as this does not emulate their natural environment.
The aim of this study was to describe the kinematics of the trunk during gait of people with stroke. In summary, we found that the trunk remained relatively still during gait, but with significant asymmetries between the affected and unaffected sides. The participants were all functional walkers at a community level, yet still exhibited this asymmetry. It may be that rehabilitation needs to target the trunk as well as the limbs in hemiparetic gait.