Postural Alignment Is Altered in People With Chronic Stroke and Related to Motor and Functional Performance

• Published in: Journal of neurologic physical therapy Vol. 38; no. 4; pp. 239 - 245
• Main Authors: Verheyden, Geert, Ruesen, Carolien, Gorissen, Monique, Brumby, Victoria, Moran, Rachel, Burnett, Malcolm, Ashburn, Ann
• Format: Journal Article
• Language: English
• Published: United States Neurology Section, APTA 01-10-2014; Neurology Section - American Physical Therapy Association
• Subjects: Aged; Clinical outcomes; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Motor ability; Postural Balance - physiology; Posture; Posture - physiology; Psychomotor Performance - physiology; Stroke; Stroke - physiopathology
• ISSN: 1557-0576; 1557-0584
• DOI: 10.1097/NPT.0000000000000054

BACKGROUND AND PURPOSE:Trunk control is impaired after stroke but little is known about how changes in posture relate to other deficits. We examined spinal postural alignment in people with chronic stroke and explored the relationship between postural alignment and clinical measures.
METHODS:Twenty-one subjects with stroke and 22 age-matched healthy comparison subjects participated in this observational, cross-sectional study. Data collection included measurements of thoracic, lumbar, sacral, and overall postural alignment in the sagittal plane in both sitting and standing. Measurements were made in different postures, includingupright, flexed forward, and extended backward. Clinical outcome measures included the Trunk Impairment Scale and its subscales, Fugl-Meyer Scale, Berg Balance Scale, Barthel Index, and Stroke Impact Scale.
RESULTS:Significant deviations in postural alignment for participants with stroke compared with comparison subjects were apparent in sacral alignment (P < 0.02) and overall postural alignment (P < 0.01) in standing. These measurements were also significantly correlated with clinical outcome measures poststroke. Participants with stroke who had a more forward leaning posture when upright scored worse on the coordination subscale of the Trunk Impairment Scale (r = −0.61) and Berg Balance Scale (r = −0.64). Participants with greater anterior pelvic tilt when flexed forward and more overall inclination when flexed forward and extended backward scored better on the Trunk Impairment Scale, its subscales, and Berg Balance Scale (r = −0.6-0.7).
DISCUSSION AND CONCLUSIONS:People with chronic stroke have altered postural alignment in standing compared with subjects without neurological deficits. Investigating interventions focusing on increasing anterior and posterior pelvic tilt seem warranted.Video Abstract available. See video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A76) for more insights from the authors.