Trunk and gait performance after stroke

Ondertitel:a biomechanical approach

Approximately 80 percent of all stroke survivors show mobility deficits after their diagnosis and select gait recovery as the primary therapy goal. However, gait is not merely the ability to walk up and down a corridor. People living with stroke need to walk independently, on unstable surfaces, in crowded environments while performing dual tasks. To optimize their walking pattern, we need to understand the underlying impairments. The importance of the trunk during walking is often neglected and still misconceived. The aim of this thesis was to enhance our understanding about the trunk’s involvement during walking after stroke and how the walking pattern recovers by resolving truncal deficits. Detailed analysis of the literature provided knowledge concerning the state of the art on trunk motion and trunk rehabilitation, whereby gaps were identified and further investigated. First, an instrumented gait analysis was performed on 57 stroke survivors and 105 healthy individuals during a cross-sectional study. The use of the Full Body Plug-In Gait model (Vicon), together with a specified trunk model and electromyography, made comparison of trunk and lower limb kinematics, spatiotemporal step parameters and muscle activity between healthy adults and stroke survivors possible. Second, of the participants with stroke, 39 were included in a randomized controlled trial receiving either trunk or cognitive training. Findings suggest that important deviations in trunk kinematics during walking were present after stroke. Stroke survivors walked with increased mediolateral/anteroposterior trunk movements, increased thoracic flexion, a neutral position of the pelvis during stance, a pelvic hike during swing, and a backward rotation of the hemiplegic thorax and pelvis resulting in more in-phase coordination. In addition, patients with more severe lower limb impairments had more pronounced deficits in truncal motion, especially in the frontal plane. Second, trunk training was able to improve balance and mobility. These improvements in gait performance were not secondary to changes in lower limb kinematics but due to decreased anteroposterior movements of the thorax and an increase in the fatigue-resistance of trunk muscles. The results of this thesis showed that trunk impairments are clearly present during walking after a stroke. By giving patients trunk exercises, their walking pattern was optimized which ensures us that trunk exercises should be incorporated in treatment strategies for gait recovery. Results suggest that stroke survivors adopted a more energy efficient walking pattern after trunk training. However, this was not directly investigated in the current trial and necessitates further study.

Jaar van publicatie:2020

Trefwoorden:Doctoral thesis

Toegankelijkheid:Open