Efect of non-affected lower limb constraint and seat height on the motor performance of hemiparetics post stroke during sit-to-stand / Efeito da restrição do membro inferior não-afetado e a altura do assento sobre o desempenho motor de hemiparéticos durante o movimento de sentado para de pé

AUTOR(ES)

André de Souza Rocha

DATA DE PUBLICAÇÃO

2009

RESUMO

Hemiparesis following stroke reduces the ability to use the involved lower extremity during the sit-to-stand (STS) transfer, thus affecting the performance. This study investigated in hemiparetic subjects the combined effects of the non-affected lower limb (NA) constraints by supporting it on a step and the seat height for the weight-bearing on the affected lower limb (AF) and the reduction of asymmetry during STS. Thirteen adult subjects (60,4 5,7 years) were selected, of both sexes, with hemiparesis due to stroke in chronic stage (43,7 50 months). They had mild to moderate impairments on the Fugl-Meyer Scale (24,7 4,9 points). The participants underwent clinical evaluations and biomechanical analyses of the kinetics and kinematics of the movements of interest. Individuals stood up from a instrumented bench at two seat heights, 100% (normal) and 130% (elevated) from the knee height (KH). There were four conditions of the feet: (1) spontaneous (SPO), (2) symmetric (SYM), (3) asymmetrical (ASS) with the NA limb in front of the AF, and (4) step (STP) of the NA limb supported on a step. Force plates and a kinematic system were used for analyses of the vertical component (Fz) of the ground reaction forces and the kinematic behaviors of the resulting movement. The results showed significant decreases of the asymmetry in the step condition compared to the positions of the SPO (p<0001), SYM (p<0001) and ASS (p=0023). The angles of hip, knee and ankle reached normal values. With the elevation of the seat height at 130%, KH had significant reductions in the time of movement and the anterior displacement of the trunk (p<0001 both). The restriction of the AF by the step was efficient in reducing the asymmetry in the STS and may be a therapeutic resource to be used in reversing the learned non-use. Raising the seat height reduced the time and displacement of the trunk, there facilitated reaching the upright position even with the use of step. The use of constraint as a strategy for training is suggested to reduce the asymmetry in the STS.

ASSUNTO(S)

acidentes vasculares cerebrais sentado para de pé kinetic hemiplegia cinemática educacao fisica sit-to-stand physiotherapy hemiparesis fisioterapia cerebrovascular disease cinética kinematics hemiparesia hemiplegia

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