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Titus A.W.1, Hillier S.2, Louw Q.1, Inglis-Jassiem G.1
1Stellenbosch University, Faculty of Medicine & Health Sciences, Physiotherapy, Cape Town, South Africa, 2University of South Australia, Sansom Institute, International Centre for Allied Health Evidence, Adelaide, Australia
Background: Approximately two out of three people with stroke experience gait restrictions. The trunk, also known as thorax, plays an important role in the symmetry, balance and stability of the lower and upper body during gait but has rarely been investigated after stroke.
Purpose: To describe the three dimensional kinematics of the thorax during gait in people with stroke.
Methods: Seventeen subjects that met the following inclusion criteria: males and females; 18 years and older; with first ever stroke; ability to follow simple instructions and to walk 10 metres without assistive devices; were recruited by means of convenience sampling for this cross-sectional pilot study.
The eight-camera T-10 Vicon (Ltd) (Oxford, UK) system with Nexus 1.8 software and the Plug-in-Gait (PIG) model (Vicon Motion System Limited, Oxford, UK) were used to capture the participants during walking at a self-selected speed. Thorax kinematics and temperospatial parameters were performed in MATLAB (The Mathworks, Natrick, MA) using custom-built scripts. The differences between the two sides (affected and less affected) were calculated using the Sign test
(statistical significance level p 0.05) (Stata software).
Results: Minimal thorax motion was noted in the sagittal plane during the full gait cycle. It remained anterior to neutral on both the affected (mean 4.28°, SD 0.87°) and less affected sides (mean 4.33°, SD 0.90°). In the coronal plane, the thorax remained central, although on the affected side the thorax tended to move downwards (-2.17°, SD 1.88°), in contrast to the less affected side (2.25°, SD 1.93°). This difference proved to be statistically significant (p=0.0001). In the transverse plane the thorax remained in a slightly backward rotated position (-3.54°, SD 2.49°) on the affected side, and slightly forward rotated (3.60°, SD 2.61°) on the less-affected side; indicating again a statistically significant difference (p=0.0001). Although participants presented with asymmetrical thorax kinematics, they achieved functional gait speeds. Five of the 17 participants in this study walked at limited community speed (0.63m/s), and the remaining 12 at community speeds (1.03m/s).
Conclusion(s): The aim of this study was to describe the kinematics of the thorax during gait of people with stroke. This pilot study found significant asymmetry in thorax motion between the affected and less affected sides in the coronal and transverse planes throughout the full gait cycle. This suggests the thorax may need to be targeted in clinical gait retraining post stroke.
Implications: In this study, thorax motion in people with stroke differed from that expected during normal gait. This took the form of reduced general motion with a tendency to lean forward, to the side and to rotate backward on the affected side. These characteristics arguably reduce efficiency/increase energy and therefore require amelioration. However this objective is not yet supported by evidence. Until such evidence appears, and in the interests of patient-centred care, we recommend that symmetry should be a goal in rehabilitation. Facilitating this symmetry may lead to a more normal gait pattern in people with stroke.
Funding acknowledgements: Self- funded Masters research project
Topic: Human movement analysis
Ethics approval: Ethical approval was granted by the Human Research Ethics Committee (HREC) of Stellenbosch University (reference number: S13/03/056).
All authors, affiliations and abstracts have been published as submitted.
