Head positions and head movements used by people following acute stroke

Abstract

In this thesis, a tool with which to describe the head activity demonstrated by patients with stroke, the Head Activity Test (HAT), was developed. The HAT was used to describe the head activity used by patients and healthy adults during five seated functional tasks (upright sitting, visual search, communication, eating, and reaching). Two hundred and sixty-three descriptors of head activity were identified from five sources (literature, clinical practice, clinicians, researchers, and patients). The descriptors were short-listed to ten measurable tool items from which the HAT was designed.

The head activity of 20 healthy adults (median age 49) was characterised using the HAT. The results showed a ‘typical’ pattern of head activity demonstrated by the healthy adult sample, characterised by a median HAT score of 10 (range 8-10), achievement and maintenance of an upright head and trunk position in sitting, dissociation of head and trunk movement, and the demonstration of head righting. Sixteen patients were recruited to a prospective observational study of head activity following stroke. Patients were assessed on three occasions (weeks one, three, and six). At week one, wide variation in head activity was demonstrated with HAT scores ranging from 0-10. HAT score was positively correlated with ADL ability (p=.007), motor impairment (p=.006), balance (p=.002), and sensory impairment (p=.004).

The findings suggest that abnormalities of head activity are common following stroke, are associated with stroke type and severity, and show recovery in the first six weeks. Further studies are required to explore the impact of abnormalities of head activity on functional outcome, and the role of targeted intervention to improve head and trunk activity in the recovery of postural control and function.

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