Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke.

OBJECTIVE: Compare kinetic energy and duration of task during sit-to-stand and curb-climbing of two groups: hemiparetic stroke patients and matched controls. For patients, describe relationships between selected physical impairments and sit-to-stand and curb-climbing performance. DESIGN: Descriptive and correlational.Background. Measures and treatments are best selected after specific limitations in functional activities (e.g., sit-to-stand) and related impairments are identified. METHOD. Fifteen patients, 29-77 (mean=53.7) years with recent stroke and 15 demographically matched healthy controls participated. Physical performance variables measured were standing balance, maximum paretic extremity weight-bearing, and knee extension strength. Sit-to-stand and curb-climbing performance were characterized using kinetic energy and task duration. Differences in physical and functional performance between groups were determined. Spearman correlations were calculated between patients' physical impairments and sit-to-stand and curb-climbing performance. RESULTS: Compared to controls, patients demonstrated reduced kinetic energy (P< or =0.003) and prolonged duration (P< or = 0.001) for sit-to-stand and curb-climbing. Significant relationships (r(s)=0.49-0.50) were demonstrated between sit-to-stand kinetic energy and knee extension strength, standing balance, and maximum weight-bearing. For curb climbing, significant relationships (r(s)=0.45) were found between kinetic energy and standing balance and maximum weight-bearing. CONCLUSION: Impaired balance and maximum weight-bearing are relevant to sit-to-stand and curb-climbing limitations after stroke. RELEVANCE: Clinicians treating sit-to-stand or curb-climbing limitations have reason to measure and treat impairments in maximum weight-bearing, knee extension strength, and standing balance.

Kinematic analysis of obstacle clearance during locomotion.

This study investigated the effect of obstacles of different heights on the locomotion of 15 healthy subjects. The following parameters were studied: (1) the distance of the toe and heel markers from the obstacle during toe-off and heel contact, respectively, (2) the minimum clearance distance of the toe and heel markers, and (3) the angular displacements and velocities of the hip, knee, and ankle. Results show significant differences in joint angular kinematics and clearance distances as obstacle height increased. The kinematic and distance differences exhibited both strong linear and non-linear trends. Toe-off distance and heel contact distance did not change significantly with changes in obstacle height.

Assessing lumbar stabilization from point-light and normal video displays of manual lifting.

Routinely, physical therapists use visual observation to assess qualitatively a patient's performance. The literature, however, indicates that assessments of gait and lumbar stabilization from visual observation are at best only moderately reliable. Point-light video displays have been used to study the visual perception of human motion. The present purpose was to examine the reliability of assessments made by a physical therapist when viewing point light and normal video displays of subjects performing a lifting task. Three physical therapists assessed lumbar stabilization by viewing normal and point-light displays of 25 subjects who lifted an 8-lb. milkcrate from floor to waist height. Greater agreement of the therapists' ratings of lumbar stabilization was achieved on assessments made from point-light displays than on those made from normal displays. This finding suggests that the use of point-light displays may improve the reliability of qualitative assessments of performance on motor tasks.