Kusumaningsih Widjajalaksmi, Triangto Kevin, Salim Harris
Department of Physical Medicine and Rehabilitation Cipto Mangunkusumo Hospital.
Neuroscience and Brain Development Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, University of Indonesia Jakarta.
Medicine (Baltimore). 2019 Sep;98(38):e17210. doi: 10.1097/MD.0000000000017210.
Impaired turning patterns have been considered as 1 factor which potentially leads to disability in chronic stroke patients. Mobility comprises 80% of the chief disability, and would eventually lead to falls. Expanded Timed Up and Go (ETUG) is an effective mobility assessment method. It utilizes video recording to analyze the conventional Time Up and Go (TUG) Test components, which includes turning pattern analysis.
Six healthy males without stroke history and 21 chronic ischemic stroke males (divided into subjects with or without the presence of flexor synergy pattern subgroups) capable of independent ambulation were recruited from Neurology and Medical Rehabilitation Department outpatient clinic. ETUG tests were recorded for each subject and were analyzed thoroughly using a computer program.
Timed Up and Go time was significantly different between the 3 groups (P = .001). As compared to control, and synergy absent group, median turning time was highest in chronic stroke patients with presence of flexor synergy by 2786 ms (P = .002), but was not significantly different in percentage ETUG (14%, P = .939). Further analysis revealed that Brunnstrom stage and number of steps taken for turning significantly affect TUG duration. Other factors such as hemiparetic side, or body height were not significantly associated.
The presence of flexor synergy would significantly affect turning time, this would then correlate to the disability of shifting body's center of gravity, as a part of the Stroke core set of International Classification of Functioning, Disability, and Health (ICF).Therefore, stroke patients need to have early ambulatory training regarding pivoting motion rather than solely focusing on straight walking. Instead of hemiparetic side, it is possible that overall turning time is affected by coordination and orientation capability, signifying the importance of cortical plasticity.
异常的转身模式被认为是导致慢性中风患者残疾的一个潜在因素。行动能力占主要残疾的80%，并最终会导致跌倒。扩展的计时起立行走测试（ETUG）是一种有效的行动能力评估方法。它利用视频记录来分析传统的计时起立行走测试（TUG）的组成部分，其中包括转身模式分析。
从神经内科和医学康复科门诊招募了6名无中风病史的健康男性以及21名能够独立行走的慢性缺血性中风男性（分为有或无屈肌协同模式亚组的受试者）。对每个受试者进行ETUG测试，并使用计算机程序进行全面分析。
三组之间的计时起立行走时间有显著差异（P = 0.001）。与对照组和无协同作用组相比，存在屈肌协同作用的慢性中风患者的中位转身时间最高，比对照组高2786毫秒（P = 0.002），但在ETUG百分比方面无显著差异（14%，P = 0.939）。进一步分析显示，Brunnstrom分期和转身步数对TUG持续时间有显著影响。其他因素，如偏瘫侧或身高，与TUG持续时间无显著关联。
屈肌协同作用的存在会显著影响转身时间，这与身体重心转移的残疾情况相关，而身体重心转移是《国际功能、残疾和健康分类》（ICF）中风核心集的一部分。因此，中风患者需要尽早进行关于枢轴转动动作的步行训练，而不是仅仅专注于直线行走。整体转身时间可能受协调和定向能力的影响，而非偏瘫侧，这表明了皮质可塑性的重要性。
