ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 December;57(6):859-65

DOI: 10.23736/S1973-9087.21.06841-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Turning difficulties after stroke and its relationship with trunk function

Pei-Jung LIANG ¹, Valeria J. CHIU ¹, Yann-Cherng TENG ¹, Huei-Ling CHIU ², Shu-Chun LEE ² ✉

¹ Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; ² School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan

BACKGROUND: Turning difficulties has been reported in stroke patients, but most studies have indicated no differences in turning direction regarding turn time or steps. Recent evidence shows that turning difficulty may correlate with trunk control. Trunk flexibility and strength are considered essential to trunk control, but their association with turning performance has not been elucidated.
AIM: The study investigated the differences in turning direction in terms of turn duration and angular velocity and the relationship between turning performance and trunk function in patients with chronic stroke.
DESIGN: Cross-sectional study.
SETTING: Outpatient clinic at the Department of Physical Medicine and Rehabilitation.
POPULATION: Chronic stroke patients.
METHODS: Twenty-eight stroke patients were evaluated for turning performance and trunk function. Turn duration and angular velocity were assessed using three wearable sensors during 360° turning in place towards both sides. Trunk function, such as flexibility, strength, and control was measured using a tape measure, a microFET3 dynamometer, and the Trunk Impairment Scale.
RESULTS: Stroke patients showed significantly longer turn durations (4.62±2.08 vs. 3.59±1.93 s, P=0.036) and lower angular velocity (118.67±35.78 vs. 135.26±42.41°/s, P=0.009) during turning toward the paretic side than towards the nonparetic side. The turning parameters towards the paretic side associated with trunk flexion (r=-0.550, P=0.003) and rotation (r=0.409, P=0.034), trunk flexor strength (r=-0.387, P=0.046), dynamic sitting balance (r=-0.383, P=0.049) and coordination of trunk movement (r=-0.494, P=0.009). However, no relationship was observed between trunk function and turning towards the nonparetic side.
CONCLUSIONS: Stroke participants experienced greater difficulty turning towards the paretic side. Trunk flexibility, strength, and control may affect turning performance, especially when turning towards the paretic side, which could explain the occurrence of falls after a turn towards the paretic side.
CLINICAL REHABILITATION IMPACT: Stroke patients experience turning difficulties, particularly during turning towards the paretic side. Stroke patients with limited trunk function are more likely to experience turning dysfunction. Clinical therapists should develop effective strategies for enhancing turning ability through improvement of trunk flexibility, strength, and control for clinical rehabilitation practice.

KEY WORDS: Accidental falls; Stroke; Torso