Relationship between trunk control and recovery of upper extremity function in stroke patients

Abstract

Stroke affects the ability of the trunk muscles to maintain an upright posture and maintain the base of support during static and dynamic postural adjustments. The trunk is considered an important postural stabilizer which enables the dissociation of the upper extremity from the trunk for function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. The association between trunk control and recovery of upper extremity function in stroke patients is not known currently.

The cross-sectional studies (Phase 1A and Phase 1B studies) investigated the relationship between trunk control and upper extremity function in 45 subacute stroke and 25 chronic stroke participants, and 34 age- and sex-matched healthy controls.
Trunk control and upper extremity function were assessed using the Trunk Impairment Scale (TIS) and Streamlined Wolf Motor Function Test (SWMFT) respectively. The participants performed SWMFT tasks, with and without an external trunk support in random order. Kinematic data were captured with the Vicon motion capture system in the Phase 1A study with chronic stroke participants and healthy controls. With trunk support, there was statistically significant improvement in trunk control (TIS) of subacute and chronic stroke participants; improvement in SWMFT performance time (SWMFT-Time) of the upper extremity of the stroke participants and the healthy controls; and improvement in SWMFT-Functional Ability Scale (SWMFT-FAS) in stroke participants. There was also statistically significant improvement in movement smoothness and elbow extension of the affected upper extremity of chronic stroke participants. The findings suggest that stabilization of the trunk enables an improved ability to use the upper extremity for functional activities. Significant strong associations were found between trunk control and upper extremity impairment (Fugl-Meyer score, FMA) and upper extremity function (SWMFT-Time and SWMFT-FAS).

The longitudinal study (Phase 2 study) examined the recovery pattern of trunk control and upper extremity impairment and function in 45 subacute stroke participants in the first 6 months following stroke. The results further confirmed the findings of the cross-sectional studies (Phase 1A and Phase 1B studies) about the strong association between trunk control and upper extremity in the first 6 months post stroke. The rate of change of the recovery curves of trunk control and upper extremity impairment was found to be similar over time. As TIS scores improved over time, both the upper extremity impairment (FMA) and upper extremity function (SWMFT-Time and SWMFTFAS) improved almost in parallel with the TIS increase. The results imply that trunk control has an association with the recovery of the upper extremity.
This PhD work has deepened our understanding about trunk control and upper extremity in people with stroke and provided valuable insights for rehabilitation professionals and researchers. The findings will assist therapists to design comprehensive programmes for rehabilitation of trunk control and upper extremity at different stages of stroke recovery; and aid in the prognostication of trunk and upper extremity recovery post stroke and therefore, will have an impact on clinical practice.

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Identifiers

ORCID for Jane Burridge: orcid.org/0000-0003-3497-6725

ORCID for Ann-Marie Hughes: orcid.org/0000-0002-3958-8206

ORCID for Martin Warner: orcid.org/0000-0002-1483-0561

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