Systematic Review of Trunk Biomechanics in Hemiplegic Gait Post-Stroke

What are common trunk impairments following a stroke?

Decreased trunk coordination and limited trunk muscle strength.

What biomechanical changes occur during walking in stroke patients?

Increased mediolateral trunk sway and larger sagittal motion of the lower trunk.

How does walking speed influence trunk biomechanics in stroke patients?

More natural trunk movements are observed with increased walking speed.

What is the pelvic step phenomenon?

At certain walking speeds, pelvic rotations contribute to step length.

What are the primary outcome measures assessed in studies of trunk biomechanics after stroke?

Kinematics, kinetics, and muscle activity during walking.

What is the significance of trunk kinematics during hemiplegic gait?

Trunk kinematics significantly alter during pathological gait, affecting overall mobility.

What defines the upper trunk (UT) and lower trunk (LT) in this study?

UT includes the shoulder girdle and thorax; LT includes the abdomen and pelvic girdle.

What is the role of the trunk during normal walking?

The upper and lower trunk move in a coordinated yet opposite direction around the vertical body axis.

What is the effect of trunk impairments on muscle activity in stroke patients?

Both the paretic and non-paretic sides show reduced activity levels and delayed onset times.

What is the Newcastle-Ottawa Scale used for in this review?

To assess the risk of bias in the included studies.

What databases were systematically searched for this review?

MEDLINE, Web of Science, Cochrane Library, ScienceDirect, and Rehabdata.

What was the aim of this systematic review?

To gain insight into trunk biomechanics during walking in stroke patients compared to healthy individuals.

What are the two main focuses of the review?

Trunk biomechanics during walking and the influence of walking speed on these biomechanics.

What is the significance of differentiating between compensatory trunk movements and intrinsic trunk control deficits?

It is crucial for developing effective rehabilitation strategies.

What is the relationship between trunk kinematics and walking speed in healthy individuals?

Increased walking speed leads to more out-of-phase trunk movements.

What type of studies were excluded from the review?

Systematic reviews, meta-analyses, and case studies.

What are the key components of trunk kinematics?

Displacements and range of motion (ROM) in the sagittal, frontal, and transverse planes.

What is the purpose of understanding trunk biomechanics after stroke?

To address these changes adequately in therapy and optimize rehabilitation strategies.

What are the implications of increased trunk sway in stroke patients?

It indicates instability and asymmetry in trunk movements.

What is the significance of the PRISMA guidelines in this review?

They ensure a systematic and transparent approach to the literature review process.

What does the term 'kinematics' refer to in the context of trunk biomechanics?

The study of motion without considering the forces that cause it.

What is the role of assistive devices and orthoses in stroke rehabilitation?

They may help control trunk impairments and improve gait stability.

What is the impact of trunk impairments on gait rehabilitation strategies?

Understanding these impairments can redirect and enhance rehabilitation approaches.

What does the systematic review aim to compare?

Trunk biomechanics during walking in stroke patients versus healthy individuals.

What methods were used to collect data in the gait analysis?

Data were collected using full body gait analysis or tri-axial accelerometers, force plates for kinetics, and electromyography for muscle activity.

What were the eligibility criteria for the studies included in the review?

Studies had to include adult participants (age 18 or older) with a primary diagnosis of stroke and a control group of healthy individuals.

What is the purpose of the Newcastle-Ottawa Scale (NOS) in assessing studies?

The NOS assesses the risk of bias in non-randomized controlled trials based on selection, comparability, and exposure or outcome.

What does a score of 7 or higher on the NOS indicate?

A score of 7 or higher is considered good quality.

What is the significance of trunk kinematics in gait analysis?

Trunk kinematics includes the motion of the trunk and its segments, relative motion of segments, and variability of trunk motion.

What does trunk stability measure in gait analysis?

Trunk stability is measured by root mean square (RMS), local stability, and orbital stability.

How is trunk symmetry assessed?

Trunk symmetry is assessed by determining the symmetry ratio of the paretic and non-paretic sides and calculating an asymmetry index.

What does a phase difference of 180 degrees indicate in trunk movement?

A phase difference of 180 degrees indicates a perfect antiphase movement, where the shoulder and pelvic girdle move in opposite directions.

What was the total number of studies identified as relevant after the systematic search?

A total of 16 studies were identified as relevant and included in the review.

What is the purpose of hand searching reference lists in systematic reviews?

Hand searching reference lists helps to find additional studies that may not have been identified through electronic databases.

What does the term 'local instability' refer to in gait analysis?

Local instability quantifies how much each trajectory moves towards or away from its nearest neighbor trajectory in response to perturbations.

What is the maximum score achievable on the Newcastle-Ottawa Scale?

The maximum score is nine stars.

What does the term 'orbital stability' measure?

Orbital stability measures the response to perturbations from one cycle to the next, quantifying how trajectories move towards or away from the central cycle trajectory.

What is the significance of the continuous relative phase (CRP) in trunk coordination?

CRP describes the difference in movement between the shoulder and pelvic girdle.

What criteria were used to assess the methodological quality of studies?

The methodological quality was assessed using the Newcastle-Ottawa Scale, which includes criteria for selection, comparability, and exposure.

What does a symmetry score of zero indicate?

A symmetry score of zero indicates perfect symmetry between the paretic and non-paretic sides.

What is the role of three independent reviewers in the study selection process?

Three independent reviewers screened studies for eligibility based on title and abstract, and assessed remaining studies through full-text evaluation.

What does the term 'asymmetry index' refer to in trunk analysis?

The asymmetry index quantifies the degree of asymmetry between the paretic and non-paretic sides.

What is the significance of determining the effects of walking speed on trunk kinematics?

It helps to understand which kinematic parameters are influenced by variations in walking speed.

What is the maximum number of stars that can be awarded in the comparability category of the NOS?

A maximum of two stars can be awarded in the comparability category.

What is the purpose of extracting data from studies in a systematic review?

Data extraction summarizes methodology and evidence, including study design, population, gait analysis equipment, and outcome measures.

What does a score of C indicate in the Level of Evidence (LOE) grading?

A score of C indicates non-comparative studies.

What does the term 'kinetics' refer to in the context of gait analysis?

Kinetics examines the forces acting on the body during movement.

What is the significance of assessing muscle activity in gait analysis?

Muscle activity provides information on the timing and amplitude of muscle contractions during movement.

What scale was used to assess methodological quality in the studies?

The Newcastle-Ottawa Scale

What was the median score for case-control studies on the Newcastle-Ottawa Scale?

Six out of nine

What level of evidence was assigned to thirteen studies according to the GRADE approach?

Level B, indicating comparative studies

What were the examined outcome measures in the studies?

Trunk kinematics and muscle activity

What types of devices were used for gait analysis in the studies?

3D motion capture, tri-axial accelerometer, and 2D video

What was the range of sampling rates used in the studies?

25 to 200 Hz

Where were accelerometers placed during the studies?

On the L3 spinous process

What anatomical landmarks were used for placing reflective markers in 3D motion capture?

C7, left and right acromion, and/or mid-sternum

What was the typical walking distance for the studies?

7, 10, 15, or 16 meters

How many studies allowed patients to walk with walking aids?

Two studies allowed walking with a cane

What was the mean time post-stroke for chronic stroke patients in the studies?

Two to six years

What was a significant finding regarding trunk kinematics in stroke patients?

Increased lateral sway towards the non-paretic side during stance phase

What pelvic movement was observed in stroke patients during the swing phase?

Upward pelvic movement, contrasting with downward movement in healthy individuals

What was the range of anterior pelvic tilt observed in stroke patients during stance and swing phases?

Excessive anterior pelvic tilts greater than 4 cm

What was the difference in range of motion (ROM) between upper and lower trunk in stroke patients?

Upper trunk ROM was larger than lower trunk ROM after stroke

What instability was noted in post-stroke individuals compared to controls?

Greater local and orbital instability

What percentage increase in ROM of the upper trunk was seen in the stroke group compared to matched individuals?

Approximately 15%

What was the agreement percentage between researchers on the Newcastle-Ottawa Scale?

82% agreement

What type of studies were included in the research?

Thirteen case-control studies and three cross-sectional studies

What was the classification of the remaining three studies that were non-comparative?

C-level of evidence

What did the majority of studies examine regarding trunk kinematics?

Trunk kinematics during walking in stroke patients

What was the common condition for patients during dynamic walking trials in the studies?

Patients wore their own shoes

What was the purpose of the reflective markers in the studies?

To assess upper and lower trunk motion during gait analysis

What was a notable characteristic of trunk variability in stroke patients?

Marked asymmetry between paretic and non-paretic sides

What was the significance of the pelvic obliquity angle in stroke patients?

Significant differences were found at toe-off and during swing phase

What was the observed increase in range of motion (ROM) of the upper trunk in stroke patients?

Approximately 15% compared to control individuals.

What did Kerrigan et al. find regarding trunk rotation during the swing phase in stroke patients?

They found excessive backward rotation compared to healthy individuals.

What is the significance of continuous relative phase (CRP) in trunk coordination?

CRP values were lower (more in-phase) in stroke patients than in healthy subjects, indicating less dissociation between thoracic and pelvic segments.

What effect does walking speed have on trunk kinematics according to the studies?

Walking speed affects lateral displacements, with greater displacements at lower speeds; however, results are contradictory.

What findings were reported regarding trunk stability in stroke patients?

Stroke patients exhibited greater trunk instability compared to controls, with higher normalized RMS values indicating more fluctuations.

How did trunk symmetry differ between stroke patients and healthy individuals?

Stroke patients showed more asymmetry in trunk displacements and accelerations in both the frontal and sagittal planes.

What did the asymmetry index of trunk accelerations indicate?

It was able to discriminate between controls and stroke patients, with significant differences found in both mediolateral and anteroposterior directions.

What was the overall risk of bias in the studies reviewed?

The overall risk of bias was moderate, with many studies not controlling for confounding variables.

What did the studies suggest about the relationship between walking speed and trunk movement stability?

Increased walking speed was associated with more stable and symmetrical trunk movements across all planes.

What did the studies find about trunk motion in stroke patients compared to healthy individuals?

Stroke patients showed increased trunk motion in the lateral and sagittal planes, and larger upper trunk motion in the transverse plane.

What is the Trendelenburg sign and its relevance in stroke patients?

It indicates pelvic drop during single stance due to weakness of the gluteus medius muscle, leading to compensatory leaning over to the affected side.

What did the studies conclude about the effect of walking speed on trunk rotation?

Some studies reported that trunk rotation decreased at higher speeds, while others found it increased.

What was the discriminating ability of vertical trunk acceleration in stroke patients?

It classified 85% of subjects in the hemiplegic group correctly.

What did the studies reveal about the relationship between trunk variability and stroke?

Increased trunk variability was observed in stroke patients, indicating less coordinated movement.

What was the primary purpose of the study on trunk biomechanics in stroke patients?

To gain insight into trunk biomechanics compared to healthy individuals and investigate the effect of walking speed.

How did the studies characterize trunk movements in stroke patients?

Trunk movements were characterized by increased range of motion and decreased antiphase rotation compared to non-pathological gait.

What did the studies suggest about muscle activity in stroke patients?

Trunk muscles are impaired after stroke, showing reduced activity levels and delayed onset.

What was a common finding regarding the transverse plane in stroke patients?

Stroke patients exhibited lower CRP values, indicating more in-phase motion compared to healthy individuals.

What did the studies indicate about the relationship between trunk motion and lower limb impairments?

Altered trunk movements can be compensatory for lower limb impairments and other gait problems.

What did the studies find regarding lateral trunk accelerations in stroke patients?

Greater lateral accelerations were present on the paretic side compared to healthy individuals.

What did the studies conclude about the effect of walking speed on trunk symmetry?

Most studies suggested that walking speed increases trunk symmetry, although not all found significant results.

What did the studies reveal about the timing of counter-rotation of the trunk in stroke patients?

Wagenaar et al. reported a lack of timing during counter-rotation, with no significant phase differences found.

What was the significance of the findings regarding trunk biomechanics in stroke patients?

The findings highlight the need for targeted rehabilitation strategies to address trunk instability and asymmetry.

What is the importance of differentiating between compensatory trunk movements and intrinsic trunk control deficits?

It helps in understanding the underlying causes of trunk deviations due to lower limb impairments.

What correlation was found between motor recovery of the leg and trunk kinematics?

A moderate to strong negative correlation was found between motor recovery of the leg and foot with transverse ROM of the trunk.

What relationship exists between hip adduction and knee extension torques?

There is a strong positive correlation between hip adduction and knee extension torques, and frontal pelvic motion.

How does the level of spasticity in the lower limbs relate to trunk impairments?

The level of spasticity in the lower limbs seemed to be less correlated with trunk impairments.