| Part I The postural influence on electrophysiological properties of hemiplegic patients in sit-to-stand activityObjectives:Sit-to-stand activity is a very important functional performance. The part aims to study the difference of electrophysiological properties of lower limb muscles in the activity between hemiplegic patients and normal volunteers, and the influence of posture on the activity.Methods:29 hemiplegic patients included and 21 normal volunteers as controls rose from chair in 4 different postures, which were:(1) parallel foot and upper limb in natural position; (2) parallel foot and upper limb in bobath's shaking hands position; (3) nonparetic feet 20cm ahead paretic feet and upper limb in natural position; (4) paretic feet 20cm ahead nonparetic feet and upper limb in natural position. The timing of the activity and surface electromyography activities of quadriceps, hamstring, tibialis anterior and gastrocnemius of both sides were recorded. Additionally, muscle strength of bilateral quadriceps and hamstrings was assessed through a dynamometer.Results:The strength (body weight%) of quadriceps, hamstring, tibialis anterior and gastrocnemius of patients'uninvolved side were 0.38±0.19, 0.17±0.13,0.11±0.07 and 0.16±0.10, respectively. Those of involved side were 0.24±0.13,0.08±0.10,0.05±0.06 and 0.05±0.05, respectively. Those of normal controls were 0.48±0.18,0.41±0.18,0.20±0.08 and 0.28±0.16, respectively. Except that there was no statistic difference between the strength of uninvolved quadriceps and normal controls (P=0.074), other strength of uninvolved side were all significantly weaker than the controls (P<0.01), but still statistically stronger than those of involved side. At the 1st posture, the SitTS timing of the controls and the hemiplegic patients were 1.36±0.29s and 3.97±2.41s respectively, which existed statistic difference. The SitTS timing of the hemiplegic patients at the 2nd,3rd,4th posture were 3.94±1.84s,4.37±2.28s and 4.31±2.91 s, respectively. There was no statistic difference among the 4 postures. At the 1st posture, the patients'average amplitude (μV), maximal amplitude (u V) and area under curve (u V.S) of quadriceps of uninvolved side were 97.46±7.35,402.83±49.57 and 1203.2±164.57, respectively. Those of involved were 55.39±5.98,224.72±27.08 and 652.30±90.94, respectively. Those of controls were 55.39±5.98,224.72±27.08 and 652.30±90.94, respectively. The average and maximal amplitudes of involved side were significantly smaller than those of uninvolved side and the controls (p≤0.001). The area under curve of involved side was significantly smaller than that of uninvolved side (P=0.001), but not the controls. The area under curve of uninvolved side was significantly bigger than that of the controls (P=0.006). The patients'average amplitude, maximal amplitude and area under curve of hamstrings of uninvolved side were 45.58±8.04,260.95±77.07 and 296.51±77.26, respectively. Those of involved were 25.22±2.72,124.34±18.81 and 302.41±40.52, respectively. Those of controls were 45.58±8.04, 260.95±77.07 and 296.51±77.26. The average amplitudes and area under curve of involved side were significantly smaller than those of uninvolved side (p=0.02). The average amplitudes of involved side was also significantly smaller than that of the controls (p=0.04), but not the area under curve. There were no statistic difference of the average and maximal amplitudes between the uninvolved hamstrings and the controls, but the area under curve of uninvolved hamstrings was significantly bigger than that of the controls (p=0.01). The patients'average amplitude, maximal amplitude and area under curve of tibialis anteriors of uninvolved side were 21.82±3.09,125.67±24.14 and 247.20±44.02, respectively. Those of involved were 27.42±4.66, 85.17±12.87 and 333.27±82.01, respectively. Those of controls were 48.35±5.60,163.44±17.09 and 296.73±42.32, respectively. All parameters of involved side were significantly smaller than those of uninvolved side (P<0.001). There were no statistic difference of the parameters between the uninvolved tibialis anterior and the controls, but the area under curve of uninvolved tibialis anterior showed a bigger trend (p=0.07). The average and maximal amplitude but not area under curve of the involved tibialis anterior were significantly smaller than those of the controls (p<0.05)。The patients' average amplitude, maximal amplitude and area under curve of gastrocnemius of uninvolved side were 21.82±3.09,125.67±24.14 and 247.20±44.02, respectively. Those of involved were 14.54±1.88,57.04±8.63 and 178.72±37.76, respectively. Those of controls were 17.57±1.96,98.55±15.97 and 125.97±20.09. The average and maximal amplitudes of involved gastrocnemius were significantly smaller than those of uninvolved side (p<0.05).) There were no statistic difference of the average and maximal amplitudes between the uninvolved gastrocnemius and the controls, but the area under curve of uninvolved gastrocnemius was statistically bigger than that of the controls (p=0.029). There were no statistic differences of AUC ratios of involved/uninvolved quadriceps (hamstrings) among 4 postures in hemiplegic patients. In addition, the AUC/MVC ratios of quadriceps and hamstrings in both sides of the patients (except involved quadriceps, p=0.078) were significantly bigger than those of controls (P<0.05), but there was no statistic difference between involved and uninvolved sides (P>0.05).Conclusions:Hemiplegic patients show a sort of asymmetry because the key muscle activities of the involved side are weaker than those of uninvolved side while they perform SitTS movement. The reasons of the asymmetry should be compensation of sound side, increase of muscle utilization of both sides, and hemiparesis itself. The change of foot posture may not influence the asymmetry of muscle activity in the patients, while a behind involved feet may possibly hinder SitTS movement. Therefore, a behind involved feet is not recommended as a practical strategy.Part II The test-retest reliability study of balance parameters during simulated stand-sit-stand activity in healthy young adultsObjectives:To study the test-retest reliability of the balance parameters during simulated stand-sit-stand activity in healthy adults on the polymorphic balance assessment and training system in different conditions, and to perceive the reliability of the assessment in clinical use.Methods:29 healthy adults, aged from 20 to 58 years old, made 5 repeated simulated stand-sit-stand movement with back support on the polymorphic balance assessment and training system under 3 different conditions, which are weight relieve(bearing 0.75 body weight), standard weight bearing and resistance(bearing 1.25 body weight). The volunteers were asked to control the center of gravity through visual feedback of plantar pressure during the procedure. The balance parameters during the movement, which include the average center of gravity (cm), the maximal sway in frontal plane (cm), the mean sway in frontal plane (cm), the path length (cm), the covered area (cm2) and the lateral speed (cm/s) in frontal plane were calculated by the system automatically. The test was divided into 2 parts. The second one was made one week after the first one.Results:During the simulated stand-sit-stand activity under the weight relieve condition, the 1st/2nd parameters including the average center of gravity, the maximal sway in frontal plane, the mean sway in frontal plane, the path length, the covered area and the lateral speed in frontal plane were 1.23±0.98/1.25±1.01,11.83±6.00/9.48±5.02,2.32±0.90/2.19±0.96,34.94±16.66/33.74±17.52,698.88±333.11/674.80±350.50 and 232.99±113.49/189.68±100.44, respectively. There were no statistical differences between 2 tests (P>0.05).The intraclass correlation coefficients were 0.95,0.81,0.88,0.85, 0.85 and 0.82, respectively. During the simulated stand-sit-stand activity under the standard weight bearing condition, the 1st/2nd parameters including the average center of gravity, the maximal sway in frontal plane, the mean sway in frontal plane, the path length, the covered area and the lateral speed in frontal plane were 1.24±0.90/1.09±1.29,7.05±4.41/7.74±3.22,1.89±0.69/2.02±0.84,25.87±10.43/24.51±11.44,517.37±208.58/490.15±228.73 and 141.04±88.25/154.78±64.38, respectively. There were no statistical differences between 2 tests (P>0.05). The intraclass correlation coefficients were 0.48,0.36,0.80,0.87,0.87 and 0.36, respectively. During the simulated stand-sit-stand activity under the resistance condition, the 1st/2nd parameters including the average center of gravity, the maximal sway in frontal plane, the mean sway in frontal plane, the path length, the covered area and the lateral speed in frontal plane were 0.99±0.92/0.83±1.00,6.66±4.28/6.00±2.73, 1.68±0.77/1.56±0.76,21.73±10.79/17.84±7.71,434.68±215.68/356.78±154.25 and 133.13±85.54/120.06±54.64, respectively. There were no statistical differences between 2 tests (P>0.05). The intraclass correlation coefficients were 0.90,0.38,0.90,0.79,0.79 and 0.38, respectively.Conclusions:The posturography of simulate stand-sit-stand movement is a new method of functional evaluation. The parameters including average center of gravity, the mean sway in frontal plane, the path length and the covered area, which reflect body symmetry and stability, have good test-retest reliability in healthy adults. The method has the potential to be an assistant evaluation of balance ability during the movement in view of its good repeatability.Part III The influence of different weight bearing while doing simulate stand-sit-stand exercise on body stability and symmetry in hemiplegic patientsObjectives:To Study the influence of different weight bearing while doing simulate stand-sit-stand exercise on body stability and symmetry in hemiplegic patients and healthy controls.Methods:29 hemiplegic stroke patients and 21 healthy adults made 5 repeated simulated stand-sit-stand movement with back support on the polymorphic balance assessment and training system under 3 different conditions, which are weight relieve(bearing 0.75 body weight), standard weight bearing and resistance(bearing 1.25 body weight). The subjects were asked to control the center of gravity through visual feedback of plantar pressure during the procedure. The balance parameters during the movement were calculated by the system automatically.Results:While doing simulate stand-sit-stand exercise under standard weight bearing condition, the average center of gravity, maximal sway in frontal plane, average sway in frontal plane, path length, covered area and lateral speed in frontal plane of hemiplegic patients were 3.83±3.82,5.57+3.57, 115.71±88.07,2314.26±1761.87,13.50±4.67 and 269.95±93.47, those of the normal people were 1.67±1.27,2.28±1.14,26.55±13.52,531.05±270.47, 7.62±3.37 and 152.30±67.34. The parameters of the patients were significantly bigger than those of the controls (ANOVA test, P<0.05). With alteration of weight bearing, the balance parameters concerning stability of the normal people and the patients all showed statistical differences. Among 3 conditions, which were weight relieve, standard weight bearing and resistance, the path length, covered area, maximal sway in frontal plane, lateral speed of the normal controls, and the maximal sway in frontal plane, lateral speed of the patients were significantly different (ANOVAtest, P<0.05). The parameters became smaller as weight bearing increased. The path length and covered area of the patients didn't change significantly with the altered weight bearing, but showed a trend (ANOVA test, P=0.093～0.111). There were no hemiplegic side differences on the balance parameters while doing the movement (ANOVA test, P>0.05).Conclusions:The stability and symmetry on lateral posture control of hemiplegic patients were not as good as those of normal people while doing simulate stand-sit-stand movement, but no significant difference exited between two hemisphere lesions. With increase of weight bearing, the normal people and the patients all showed better posture stability, but not the symmetry.PartⅣThe study of correlations between sit-to-stand activity of hemiplegic patients and its influencing factorsObjectives:To study the correlations among timing sit-to-stand, stability and symmetry in simulated stand-sit-stand activity, muscle strength, tone, somatosensory and motor function in hemiplegic patients.Methods:29 hemiplegic patients were timing in the actual sit-to-stand activity, and did the simulated stand-sit-stand activity on the polymorphic balance assessment and exercise system, by which the balance parameters could be calculated automatically. Other assessments included key muscle strength of hip, knee and ankle joints, tone of plantarflexors, position sense of ankle, Berg Balance Scale, Rivermead Motor Index, Simplified Fugl-Meyer assessment of lower limb, timed sit-to-stand and Barthel Index. The correlations among timing sit-to-stand, balance parameters and results being evaluated above were analyzed statistically.Results:The timed sit-to-stand was negatively and moderately correlated with uninvolved quadriceps strength (r=-0.40, P<0.05. It was not statistically correlated with involved quadriceps strength, but there was a trend (r=-0.326, P=0.097). It was not statistically correlated with other muscles'strength (P>0.05). It was not statistically correlated with the tone of plantarflexors and position sense of ankle (P>0.05).The balance parameters of simulate stand-sit-stand movement on normal weight bearing were not statistically correlated with the tone of plantar flexors, position sense of ankle, and strength of both sides (P>0.05). They were not statistically correlated with Berg Balance Scale, Rivermead Motor Index, Simplified Fugl-Meyer assessment of lower limb and Barthel Index, either(P>0.05).Conclusions:Quadriceps strength is correlated with timed sit-to-stand. We failed to find the correlation between balance parameters of simulate stand-sit-stand movement and other motor function assessments.Part V The effect of simulate stand-sit-stand exercise through visual feedback on hemiplegic patients:A random control study.Objectives:To study the possibility that simulate stand-sit-stand exercise through visual feedback improves stability and symmetry of SitTS/StandTS activity, motor function and ADL of hemiplegic patients.Methods:29 hemiplegic patients were randomly divided into 2 groups. The 1st group of 12 patients did visual feedback exercise (5 times per week,20 min per time,4 weeks) plus traditional exercise (5 times per week,40 min per time,4 weeks), and the 2nd group of 17 patients did traditional exercise only. The special designed visual feedback exercise underwent on the polymorphic balance assessment and exercise system. The timed sit-to-stand and 10-meter-walk, balance parameters of simulate stand-sit-stand motion, strength, Simplified Fugl-Meyer Assessment of lower limb, Berg Balance Scale, Rivermead Motor Index and Barthel Index were evaluated before and after rehabilitation procedure.Results:Before the treatment, the timed sit-to-stand and 10-meter-walk, Simplified Fugl-Meyer Assessment of lower limb, Berg Balance Scale, Rivermead Motor Index and Barthel Index of the 1st group were 3.05±1.02s, 36.07±16.74s,3.30±0.67,19.80±3.26,37.50±8.95 and 9.60±2.72, respectively. Those of the 2nd group were 4.24±2.70s,54.87±29.04s, 2.94±0.97,19.41±5.22,27.47±15.47 and 7.53±3.47, respectively. There were no statistic differences between 2 groups (ANOVA or Mann-Whitney U test, P>0.05). After the treatment, the values of the 1st group were 2.93±0.95s, 28.19±6.95s,3.80±1.03,24.50±3.10,44.30±4.62,11.60±1.71 and 85.50±8.65, and those of the 2nd group were 3.99±2.44s,47.43±27.36s, 3.41±1.00,21.94±4.79,33.76±15.28,9.82±3.30 and 71.18±15.57, respectively. There were significant improvement of motor function in both groups (Mann-Whitney U test, P<0.05). After the treatment, the timed sit-to-stand and 10-meter-walk of both groups differed statistically (ANOVA test, P<0.05). There were no significant differences of the other motor function assessments between 2 groups (Mann-Whitney U test, P>0.05). Before the treatment, there were no significant differences of balance parameters of simulate stand-sit-stand motion between groups (Mann-Whitney U test, P>0.05). After the treatment, the average sway in frontal plane of the 1st group was statistically smaller than that of the 2nd group (Mann-Whitney U test, P=0.035), while there were no significant differences of the other balance parameters of simulate stand-sit-stand motion between groups (Mann-Whitney U test, P>0.05).Conclusions:The simulate stand-sit-stand exercise through visual feedback is a newly designed exercise, which might be with an extra benefit on improving posture stability and motor function.
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