Terui Y1, Suto E2, Iwasawa S2, Uemura S1, Hasegawa K3, Satake M1, Shioya T1
1Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan, 2Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Department of Rehabilitation, Daisen, Japan, 3Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Department of Rehabilitation, Daien, Japan
Background: Factors that can cause walking defects in individuals after they experience a stroke include motor paralysis, sensory impairment, and changes in muscle tone. The gait in stroke patients can thus quickly become asymmetrical. The Lissajous Index (LI) visually and numerically evaluates the left-right symmetry from trunk acceleration data. The LI has been quite useful for examinations of healthy subjects and patients with hip osteoarthritis, but the LI has not been evaluated or adjusted for stroke patients.
Purpose: Here we sought to determine the intra-rater reliability and absolute reliability of the LI in evaluating the symmetry of trunk movement during gait in stroke patients. We also compared the LIs of patients with stroke with those of healthy subjects, and examined the relationship between the LI and body function in patients with stroke.
Methods: Twenty-one healthy subjects (age 63.3±2.0 yrs) and 45 patients with stroke (age 58.7±13.4 yrs) walked 10 m wearing a tri-axial accelerometer at the level of the L3 spinous process. We analyzed the medio-lateral acceleration and vertical acceleration expressed as continuous waveforms and the bilateral areas surrounded by the waveforms as the LI. An LI of 0 indicates perfect symmetry. In the stroke group, we evaluated the Stroke Impairment Assessment Set, the muscle tone of the paralysis-side leg of the Modified Ashworth Scale (MAS), the muscle strength of knee extension and flexion, and standing balance with the Berg Balance Scale (BBS). The LI and other outcomes were evaluated at baseline when the stroke patients started to walk 10 m without arm support, and at 1 month of follow-up. We determined the intra-class correlation coefficients (ICCs) and performed a Bland-Altman analysis for the relative reliabilities of the LIs of the stroke patients. We examined the relationship between the LI and body function in the stroke group.
Results: The ICC of the LI of the patients with stroke was 0.938 (p 0.05). There was no fixed bias or proportional bias in the LIs of the stroke patients. The mean±SD of the LIs in the healthy and stroke groups were 21.1±14.1% and 51.2±37.6%, respectively. The LIs of the stroke patients were significantly larger than those of the healthy subjects (p 0.01). The BBS score was significantly correlated with LI in the stroke group (r= −0.413). The mean time-dependent change in the LI (ΔLI) was 14.9±24.6%. The ΔLI correlated with the change in the MAS scores (triceps surae muscle) in stroke patients (r= −0.537).
Conclusion(s): The LI in the stroke patients showed high intra-rater reliability and absolute reliability. The LI measured at a comfortable gait speed in stroke patients was larger than the LI of healthy subjects, and it showed a negative correlation with the BBS score. In the stroke patients examined herein, the improvement of the gait asymmetry of trunk movement was significantly related to the patients´ improvement on the MAS.
Implications: The Lissajous Index (LI) measured during gait was useful for evaluating gait asymmetry and balance, including in stroke patients.
Keywords: Asymmetry, stroke, accelerometer
Funding acknowledgements: Our work was unfunded.
Purpose: Here we sought to determine the intra-rater reliability and absolute reliability of the LI in evaluating the symmetry of trunk movement during gait in stroke patients. We also compared the LIs of patients with stroke with those of healthy subjects, and examined the relationship between the LI and body function in patients with stroke.
Methods: Twenty-one healthy subjects (age 63.3±2.0 yrs) and 45 patients with stroke (age 58.7±13.4 yrs) walked 10 m wearing a tri-axial accelerometer at the level of the L3 spinous process. We analyzed the medio-lateral acceleration and vertical acceleration expressed as continuous waveforms and the bilateral areas surrounded by the waveforms as the LI. An LI of 0 indicates perfect symmetry. In the stroke group, we evaluated the Stroke Impairment Assessment Set, the muscle tone of the paralysis-side leg of the Modified Ashworth Scale (MAS), the muscle strength of knee extension and flexion, and standing balance with the Berg Balance Scale (BBS). The LI and other outcomes were evaluated at baseline when the stroke patients started to walk 10 m without arm support, and at 1 month of follow-up. We determined the intra-class correlation coefficients (ICCs) and performed a Bland-Altman analysis for the relative reliabilities of the LIs of the stroke patients. We examined the relationship between the LI and body function in the stroke group.
Results: The ICC of the LI of the patients with stroke was 0.938 (p 0.05). There was no fixed bias or proportional bias in the LIs of the stroke patients. The mean±SD of the LIs in the healthy and stroke groups were 21.1±14.1% and 51.2±37.6%, respectively. The LIs of the stroke patients were significantly larger than those of the healthy subjects (p 0.01). The BBS score was significantly correlated with LI in the stroke group (r= −0.413). The mean time-dependent change in the LI (ΔLI) was 14.9±24.6%. The ΔLI correlated with the change in the MAS scores (triceps surae muscle) in stroke patients (r= −0.537).
Conclusion(s): The LI in the stroke patients showed high intra-rater reliability and absolute reliability. The LI measured at a comfortable gait speed in stroke patients was larger than the LI of healthy subjects, and it showed a negative correlation with the BBS score. In the stroke patients examined herein, the improvement of the gait asymmetry of trunk movement was significantly related to the patients´ improvement on the MAS.
Implications: The Lissajous Index (LI) measured during gait was useful for evaluating gait asymmetry and balance, including in stroke patients.
Keywords: Asymmetry, stroke, accelerometer
Funding acknowledgements: Our work was unfunded.
Topic: Neurology: stroke; Human movement analysis
Ethics approval required: Yes
Institution: Akita University Graduate School of Medicine
Ethics committee: The Ethics Committees of Akita University Graduate School of Medicine
Ethics number: 1319
All authors, affiliations and abstracts have been published as submitted.
