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Naidoo P1, Mothabeng J1, Mostert K1
1University of Pretoria, Physiotherapy, Tshwane, South Africa
Background: An impairment following stroke is the inability to bear weight, as individuals bear only 25% to 43% bodyweight on the paretic limb in standing. With advancements in technology, foot force plates are widely used to determine weight bearing. Various studies have been done due to high validity and reliability of force plates in literature. However, in community-based settings or hospitals, this equipment is rarely available due to their costs (up to R200 000 per force plate), inability to train staff to utilise the equipment or difficulties to update software. Therefore alternative devices have to be developed for these settings. Therefore a case study was done which has lead to a PhD study.
Purpose: The purpose of this study was to establish the validity of foot imprints to assess lower limb weight bearing in a case study.
Methods: Design: A case study was done.
Clinical presentation:A 45-year-old female was admitted following multiple minor infarcts in the cerebrum. Analysis of gait and sit-to-stand revealed poor postural alignment (leaning to the left side), asymmetrical weight bearing through the right lower limb, poor right knee control, proprioceptive and tone deficits with inadequate dynamic standing balance. She could mobilise with the aid of a quadrupod.
Instrumentation: A substance made from water, flour, salt and boric acid (commonly used as Play-Dough) was placed with a two centimetre height on a non-slip surface. The patient was asked to manoeuvre into a standing position which was done twice before and after treatment. A simple treatment of a five-repetition sit-to-stand (5×STS) for three sets of ten repetitions was used to influence weight bearing.
Results:
The 'normal' side foot imprint is visually clearer in both images (before and after sit-to-stand). Closer analysis of the imprint of the hemiplegic foot indicates minimal but significant changes in weight bearing post treatment when compared to the normal side. Furthermore, measurements taken with a ruler (in millimetres) indicated between 1 to 1.5 mm depth changes on the right (hemiparetic).
Conclusion(s): The case report suggested that the cost-effective method using foot imprints would be a method of measuring weight bearing for stroke patients. Other cost-effective methods are also recommended which should be compared to the psychometric qualities of the goal standard assessment tool, the force plate, which will also be investigated in a forth-coming study.
Implications: A clinically cost-effective, user-friendly outcome measure would directly influence the care of the patient, as it would indicate the progression or regression needs, preventing falls, injury or secondary complications. Psychological benefits for patients and care-givers who would be able to visually analyse the changes in lower limb weight bearing. Physiotherapists in resource poor settings like hospitals, clinics, practices, home visits and rural communities would also be able to use a portable objective method . Physiotherapy educators would be able to expose students to current yet feasible outcome measures. The Department of Health would benefit due to the reduction of budgets spent in smaller hospitals and clinics on expensive equipment.
Keywords: outcome measure for lower limb weight bearing, stroke weight bearing, stroke outcome measure
Funding acknowledgements: None
Purpose: The purpose of this study was to establish the validity of foot imprints to assess lower limb weight bearing in a case study.
Methods: Design: A case study was done.
Clinical presentation:A 45-year-old female was admitted following multiple minor infarcts in the cerebrum. Analysis of gait and sit-to-stand revealed poor postural alignment (leaning to the left side), asymmetrical weight bearing through the right lower limb, poor right knee control, proprioceptive and tone deficits with inadequate dynamic standing balance. She could mobilise with the aid of a quadrupod.
Instrumentation: A substance made from water, flour, salt and boric acid (commonly used as Play-Dough) was placed with a two centimetre height on a non-slip surface. The patient was asked to manoeuvre into a standing position which was done twice before and after treatment. A simple treatment of a five-repetition sit-to-stand (5×STS) for three sets of ten repetitions was used to influence weight bearing.
Results:
The 'normal' side foot imprint is visually clearer in both images (before and after sit-to-stand). Closer analysis of the imprint of the hemiplegic foot indicates minimal but significant changes in weight bearing post treatment when compared to the normal side. Furthermore, measurements taken with a ruler (in millimetres) indicated between 1 to 1.5 mm depth changes on the right (hemiparetic).
Conclusion(s): The case report suggested that the cost-effective method using foot imprints would be a method of measuring weight bearing for stroke patients. Other cost-effective methods are also recommended which should be compared to the psychometric qualities of the goal standard assessment tool, the force plate, which will also be investigated in a forth-coming study.
Implications: A clinically cost-effective, user-friendly outcome measure would directly influence the care of the patient, as it would indicate the progression or regression needs, preventing falls, injury or secondary complications. Psychological benefits for patients and care-givers who would be able to visually analyse the changes in lower limb weight bearing. Physiotherapists in resource poor settings like hospitals, clinics, practices, home visits and rural communities would also be able to use a portable objective method . Physiotherapy educators would be able to expose students to current yet feasible outcome measures. The Department of Health would benefit due to the reduction of budgets spent in smaller hospitals and clinics on expensive equipment.
Keywords: outcome measure for lower limb weight bearing, stroke weight bearing, stroke outcome measure
Funding acknowledgements: None
Topic: Neurology: stroke; Outcome measurement
Ethics approval required: Yes
Institution: University of Pretoria
Ethics committee: Faculty of Health Sciences Ethics Board
Ethics number: 57/2018
All authors, affiliations and abstracts have been published as submitted.
