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Huang JC1, Lin SI1, Lee PY1, Tseng HY2
1National Cheng Kung University, Department of Physical Therapy, Tainan City, Taiwan, 2Tainan Hospital, Ministry of Health and Welfare, Department of Rehabilitation, Tainan City, Taiwan
Background: Trunk Impairment Scale (TIS) is developed to assess motor impairment of the trunk in people with stroke and commonly used clinically. It has been found to have high test-retest reliability and validity against Barthel Index. Its correlation with sensitive biomechanical measures has not been examined. The TIS composes of three subscales, static and dynamic balance, and trunk coordination, all tested in sitting with the feet rested on the ground. Such a testing position would allow the use of the lower limbs for support and may affect the extent to which the TIS can reflect trunk motor impairment or balance.
Purpose: To determine the association between TIS and center of pressure (COP) in sitting with and without feet support and standing in people with stroke.
Methods: Eight participants with sub-acute stroke (aged 57-79 years) who were able to maintain independent sitting for more than 20 sec went through the TIS and the Stroke Rehabilitation Assessment of Movement (STREAM) tests. For the biomechanical measures, there were three tasks, static (20 sec), and forward and lateral (to the hemiparetic side) leaning, all tested in three positions: sitting with the legs dangling (sit-LD) to prevent the use of the lower limbs for support, sitting with the feet supported (sit-FP), and standing (STAND). A force platform, placed on the chair and ground for the sitting and standing positions, respectively, was used to derive the data for COP. Each task and position was repeated twice and the mean, normalized to the height, was used for Spearman correlation analysis.
Results: The mean STREAM lower extremity and mobility scores were 14.6 (SD=5.2) and 23 (SD=6.9), respectively. The associations between the TIS static subscale and COP measures during sit-LD & sit-FP, including trajectory, range and velocity of anteroposterior (AP) and mediolateral (ML) motion and area, were all non-significant (-0.55 r 0.40, 0.13 p 0.95). The TIS static subscale was significantly correlated with quiet standing COP trajectory (r=-0.809, p=0.015) and AP velocity (r=-0.861, p=0.006), and lateral leaning distance (r=-0.76, p=0.047) in STAND. For the TIS dynamic subscale, its correlations with the COP measures in forward and lateral leaning in all the positions were non-significant (-0.67 r 0.37, 0.17 p 0.83 ). The TIS dynamic subscale had significant correlations with COP ML range (r=-0.80, p=0.01) in sit-FP, and area (r=-0.73, p=0.04) and ML range (r=-0.73, p=0.039) in STAND. For the TIS coordination subscale, its correlations with all the COP measures were non-significant (-0.55 r 0.37, 0.15 p 0.86). The TIS total score significantly correlated with COP ML range (r=-0.74 , p=0.35 ) in quiet standing but not other conditions.
Conclusion(s): The TIS subscales and total score mostly did not have significant correlations with the COP measures during sitting with or without feet support, but had significant correlations with standing balance. These findings suggested that TIS might be better in reflecting small changes in standing balance than sitting balance or trunk motor impairment.
Implications: The validity of TIS in assessing motor impairment of the trunk in people with stroke needs to be better examined.
Keywords: Stroke, Trunk Impairment Scale, center of pressure
Funding acknowledgements: None
Purpose: To determine the association between TIS and center of pressure (COP) in sitting with and without feet support and standing in people with stroke.
Methods: Eight participants with sub-acute stroke (aged 57-79 years) who were able to maintain independent sitting for more than 20 sec went through the TIS and the Stroke Rehabilitation Assessment of Movement (STREAM) tests. For the biomechanical measures, there were three tasks, static (20 sec), and forward and lateral (to the hemiparetic side) leaning, all tested in three positions: sitting with the legs dangling (sit-LD) to prevent the use of the lower limbs for support, sitting with the feet supported (sit-FP), and standing (STAND). A force platform, placed on the chair and ground for the sitting and standing positions, respectively, was used to derive the data for COP. Each task and position was repeated twice and the mean, normalized to the height, was used for Spearman correlation analysis.
Results: The mean STREAM lower extremity and mobility scores were 14.6 (SD=5.2) and 23 (SD=6.9), respectively. The associations between the TIS static subscale and COP measures during sit-LD & sit-FP, including trajectory, range and velocity of anteroposterior (AP) and mediolateral (ML) motion and area, were all non-significant (-0.55 r 0.40, 0.13 p 0.95). The TIS static subscale was significantly correlated with quiet standing COP trajectory (r=-0.809, p=0.015) and AP velocity (r=-0.861, p=0.006), and lateral leaning distance (r=-0.76, p=0.047) in STAND. For the TIS dynamic subscale, its correlations with the COP measures in forward and lateral leaning in all the positions were non-significant (-0.67 r 0.37, 0.17 p 0.83 ). The TIS dynamic subscale had significant correlations with COP ML range (r=-0.80, p=0.01) in sit-FP, and area (r=-0.73, p=0.04) and ML range (r=-0.73, p=0.039) in STAND. For the TIS coordination subscale, its correlations with all the COP measures were non-significant (-0.55 r 0.37, 0.15 p 0.86). The TIS total score significantly correlated with COP ML range (r=-0.74 , p=0.35 ) in quiet standing but not other conditions.
Conclusion(s): The TIS subscales and total score mostly did not have significant correlations with the COP measures during sitting with or without feet support, but had significant correlations with standing balance. These findings suggested that TIS might be better in reflecting small changes in standing balance than sitting balance or trunk motor impairment.
Implications: The validity of TIS in assessing motor impairment of the trunk in people with stroke needs to be better examined.
Keywords: Stroke, Trunk Impairment Scale, center of pressure
Funding acknowledgements: None
Topic: Neurology: stroke; Human movement analysis
Ethics approval required: Yes
Institution: National Cheng Kung University Hospital
Ethics committee: Institutional Review Board
Ethics number: B-ER-106-428
All authors, affiliations and abstracts have been published as submitted.
