Verheyden, G., Ashburn, A., Lawrence, J., Shepard, N. and Taylor, D.
Recovery of head and trunk coordination after stroke
At International Society for Posture and Gait Research Conference.
14 - 18 Jul 2007.
Full text not available from this repository.
Introduction: Studies in healthy individuals have described a
clear sequence of head and trunk coordination during horizontal
gaze transfers that require whole body movements. For
patients after stroke, there is evidence to suggest that sensorimotor
integration of postural adjustments and voluntarily head
movements may have been modified. The aim of our study was
to examine head and trunk coordination, in particular movement
initiation in people early after stroke.
Methods: We evaluated 6 people with stroke and 6 healthy controls.
Subjects with stroke were assessed clinically and in a laboratory
setting at three, six and 12 weeks after stroke. Control
subjects were also examined at three consecutive time points with
the same weekly interval as the stroke group. Participants were
asked verbally to rotate their head to the side of preference and
look at a visual signal placed at 90° left and right from centre.
Markers were attached at standardised positions of the body and
3-D motion recordings were made using CODAmotion. Data
analysis consisted of examining the sequence of head and trunk
rotation in both groups separately using Wilcoxon signed rank
test. Differences in degree of head rotation, shoulder rotation
and delay in rotation were analysed between groups and over
time by means ofWilcoxon ranked sum test and Friedman analysis
Results: The pattern of movement demonstrated by the healthy
controls (2 females, 4 males, median (IQR) age 64 (62-70) years)
at all three time points showed rotation of the head before rotation
of the shoulders (p=0.028). In comparison, the mildly
impaired stroke group (1 female, 5 males; median (IQR) age 70
(65-79) years) showed no significant difference between rotation
of the head and shoulder at three weeks after stroke (p=0.075).
This pattern changed over time, reflecting the sequence demonstrated
by the healthy controls, with a significant start of rotating
the head before the shoulders both at six weeks (p=0.046) and
at 12 weeks (p=0.028) after stroke.When comparing both groups
at the three time points, there was no significant difference in
degree of head rotation, shoulder rotation or in delay in rotation.
However the stroke group had a relatively smaller variability in
degree of head rotation and a larger variability in degree of shoulder
rotation in comparison to the healthy controls. The results
of the Friedman test with post-hoc analysis showed a significant
decrease in degree of head rotation for stroke patients between
three and 12 weeks after stroke (p=0.028).
Conclusions: We believe this is the first study to evaluate recovery
of the sequence of head and trunk coordination during the
acute stages following stroke. Our results suggest that people with
stroke show a modified coordination pattern early after stroke
but recover over time towards the level of healthy subjects. Future
research should include more impaired stroke patients as well as
evaluate the relation with clinical measures and thus importance
in everyday activities.
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