The aim of this paper is to explore the research literature on the turning ability among stroke survivors. Stroke is one of the top five leading causes of death and disability in Malaysia. Stroke survivors reported a higher rate of fall incidences with turning while walking has been the major contributor in most of the incidences. The attentional task requires stroke survivors to have higher cognitive and attention function, and sound muscle coordination in order to perform multitask activities such as driving, walking and turning while talking, carrying an object (holding a plastic bag), navigating corners and overcoming obstacles within the base of support. Most of the previous studies have focused on the kinematic and gait parameters measurement of turning ability among stroke survivors. However, studies conducted on muscle activity using electromyography to evaluate the time pattern of muscle contraction during turning event is lacking. With regards to dual-task ability among stroke survivors, there is insufficient information or research into dual task (motor and cognitive) ability during turning. Further studies are needed to understand the effects of dual-task activity on muscle activity and gait parameters and how this impairment affects the turning ability. This needs to be addressed in order to prevent falls among stroke survivors. 1. Introduction Stroke or cerebrovascular accident is the second most common cause of death and disability worldwide [1]. In Malaysia, epidemiological data in 2002 showed that stroke was one of the top five leading causes of death with a mortality rate of 11.9 per 100,000 population [2]. In addition, the National Stroke Association of Malaysia highlighted that around 40,000 Malaysian are disabled due to stroke every year [3]. This indicates that the high number of stroke incidences may increase demand of health services as well as increases burden to caregivers. Stroke is defined as the “rapidly developing signs of focal (or global) disturbance of cerebral function, which is lasting more than 24 hours (unless interrupted by surgery or death), with no apparent nonvascular cause” [4]. In other words, stroke is a disease caused by the disruption of blood vessels in the brain, such as ischemic and hemorrhagic [5]. Consequently, those who survived are presented with significant impairment that may affect sensorimotor, swallowing, perception, vision, emotion, cognitive, and communication which in turn may predispose them to various complications and long-term disability [6]. Fall seems to be the most common reported
References
[1]
C. J. L. Murray and A. D. Lopez, “Mortality by cause for eight regions of the world: global burden of disease study,” The Lancet, vol. 349, no. 9061, pp. 1269–1276, 1997.
[2]
Ministry of Health, “Clinical Practice Guidelines: Management of Ischaemic Stroke,” 2006, http://www.moh.gov.my/cpgs?offset=20.
P. Thorvaldsen, K. Kuulasmaa, A. M. Rajakangas, D. Rastenyte, C. Sarti, and L. Wilhelmsen, “Stroke trends in the WHO MONICA project,” Stroke, vol. 28, no. 3, pp. 500–506, 1997.
[5]
C. R. Mohamed, The educational needs of home-based stroke patients and family caregivers in Malaysia [Ph.D. thesis], Victoria University of Wellington, 2010.
[6]
H. M. Dewey, L. J. Sherry, and J. M. Collier, “Stroke rehabilitation 2007: What should it be?” International Journal of Stroke, vol. 2, no. 3, pp. 191–200, 2007.
[7]
A. Czernuszenko and A. Czlonkowska, “Risk factors for falls in stroke patients during inpatient rehabilitation,” Clinical Rehabilitation, vol. 23, no. 2, pp. 176–188, 2009.
[8]
L. Nyberg and Y. Gustafson, “Patient falls in stroke rehabilitation: a challenge to rehabilitation strategies,” Stroke, vol. 26, no. 5, pp. 838–842, 1995.
[9]
A. Forster and J. Young, “Incidence and consequences of falls due to stroke: a systematic inquiry,” British Medical Journal, vol. 311, no. 6997, pp. 83–86, 1995.
[10]
B. Belgen, M. Beninato, P. E. Sullivan, and K. Narielwalla, “The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 4, pp. 554–561, 2006.
[11]
J. E. Harris, J. J. Eng, D. S. Marigold, C. D. Tokuno, and C. L. Louis, “Relationship of balance and mobility to fall incidence in people with chronic stroke,” Physical Therapy, vol. 85, no. 2, pp. 150–158, 2005.
[12]
I. Lemberg, I. Kirchberger, G. Stucki, and A. Cieza, “The ICF core set for stroke from the perspective of physicians: a worldwide validation study using the delphi technique,” European Journal of Physical and Rehabilitation Medicine, vol. 46, no. 3, pp. 377–388, 2010.
[13]
S. Mudge and N. S. Stott, “Outcome measures to assess walking ability following stroke: a systematic review of the literature,” Physiotherapy, vol. 93, no. 3, pp. 189–200, 2007.
[14]
S. Geyh, A. Cieza, J. Schouten, et al., “ICF core sets for stroke,” Journal of Rehabilitation Medicine, vol. 36, supplement 44, pp. 135–141, 2004.
[15]
M. T. Glamcevski and J. Pierson, “Prevalence of and factors associated with poststroke depression: a Malaysian study,” Journal of Stroke and Cerebrovascular Diseases, vol. 14, no. 4, pp. 157–161, 2005.
[16]
L. Ada, S. Dorsch, and C. G. Canning, “Strengthening interventions increase strength and improve activity after stroke: a systematic review,” The Australian Journal of Physiotherapy, vol. 52, no. 4, pp. 241–248, 2006.
[17]
R. W. Bohannon and A. W. Andrews, “Relationships between impairments in strength of limb muscle actions following stroke,” Perceptual and Motor Skills, vol. 87, no. 3, part 2, pp. 1327–1330, 1998.
[18]
D. L. Smith, A. J. Akhtar, and W. M. Garraway, “Proprioception and spatial neglect after stroke,” Age and Ageing, vol. 12, no. 1, pp. 63–69, 1983.
[19]
D. K. Sommerfeld, E. U. B. Eek, A. K. Svensson, L. W. Holmqvist, and M. H. von Arbin, “Spasticity after stroke: its occurrence and association with motor impairments and activity limitations,” Stroke, vol. 35, no. 1, pp. 134–139, 2004.
[20]
P. Y. Lin, Y. R. Yang, S. J. Cheng, and R. Y. Wang, “The relation between ankle impairments and gait velocity and symmetry in people with stroke,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 4, pp. 562–568, 2006.
[21]
R. P. S. van Peppen, G. Kwakkel, S. Wood-Dauphinee, H. J. M. Hendriks, P. J. van der Wees, and J. Dekker, “The impact of physical therapy on functional outcomes after stroke: What's the evidence?” Clinical Rehabilitation, vol. 18, no. 8, pp. 833–862, 2004.
[22]
U. B. Flansbjer, D. Downham, and J. Lexell, “Knee muscle strength, gait performance, and perceived participation after stroke,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 7, pp. 974–980, 2006.
[23]
B. Bernspang, K. Asplund, S. Eriksson, and A. R. Fugl-Meyer, “Motor and perceptual impairments in acute stroke patients: effects on self-care ability,” Stroke, vol. 18, no. 6, pp. 1081–1086, 1987.
[24]
J. Desrosiers, F. Malouin, C. Richards, D. Bourbonnais, A. Rochette, and G. Bravo, “Comparison of changes in upper and lower extremity impairments and disabilities after stroke,” International Journal of Rehabilitation Research, vol. 26, no. 2, pp. 109–116, 2003.
[25]
P. Kluding and B. Gajewski, “Lower-extremity strength differences predict activity limitations in people with chronic stroke,” Physical Therapy, vol. 89, no. 1, pp. 73–81, 2009.
[26]
B. A. R. Rameezan and O. Zaliha, “Functional status of acute stroke patients in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia,” Medical Journal of Malaysia, vol. 60, no. 5, pp. 548–559, 2005.
[27]
S. B. O'Sullivan and T. J. Schmitz, Eds., Physical Rehabilitation, F.A. Davis Company, Philadelphia, Pa, USA, 2007.
[28]
D. M. Cameron, R. W. Bohannon, G. E. Garrett, S. V. Owen, and D. A. Cameron, “Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke,” Clinical Biomechanics, vol. 18, no. 4, pp. 332–340, 2003.
[29]
A. Kusoffsky, I. Apel, and H. Hirschfeld, “Reaching-lifting-placing task during standing after stroke: coordination among ground forces, ankle muscle activity, and hand movement,” Archives of Physical Medicine and Rehabilitation, vol. 82, no. 5, pp. 650–660, 2001.
[30]
R. R. Holt, D. Simpson, J. R. Jenner, S. G. B. Kirker, and A. M. Wing, “Ground reaction force after a sideways push as a measure of balance in recovery from stroke,” Clinical Rehabilitation, vol. 14, no. 1, pp. 88–95, 2000.
[31]
S. E. Lamb, L. Ferrucci, S. Volapto, L. P. Fried, and J. M. Guralnik, “Risk factors for falling in home-dwelling older women with stroke: the women's health and aging study,” Stroke, vol. 34, no. 2, pp. 494–500, 2003.
[32]
R. Teasell, M. McRae, N. Foley, and A. Bhardwaj, “The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk,” Archives of Physical Medicine and Rehabilitation, vol. 83, no. 3, pp. 329–333, 2002.
[33]
R. W. Bohannon, “Gait performance of hemiparetic stroke patients: selected variables,” Archives of Physical Medicine and Rehabilitation, vol. 68, no. 11, pp. 777–781, 1987.
[34]
P. J. Friedman, “Gait recovery after hemiplegic stroke,” International Disability Studies, vol. 12, no. 3, pp. 119–122, 1990.
[35]
A. L. Hsu, P. F. Tang, and M. H. Jan, “Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke,” Archives of Physical Medicine and Rehabilitation, vol. 84, no. 8, pp. 1185–1193, 2003.
[36]
B. Kollen, G. Kwakkel, and E. Lindeman, “Hemiplegic gait after stroke: Is measurement of maximum speed required?” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 3, pp. 358–363, 2006.
[37]
S. R. Sheldon, I. A. Kramers de Quervain, S. Leurgans, W. S. Pease, and D. McAllister, “Gait pattern in the early recovery period after stroke,” Journal of Bone and Joint Surgery, vol. 78, no. 10, pp. 1506–1514, 1996.
[38]
A. L. Hall, C. L. Peterson, S. A. Kautz, and R. R. Neptune, “Relationships between muscle contributions to walking subtasks and functional walking status in persons with post-stroke hemiparesis,” Clinical Biomechanics, vol. 26, no. 5, pp. 509–515, 2011.
[39]
C. P. McGowan, R. Kram, and R. R. Neptune, “Modulation of leg muscle function in response to altered demand for body support and forward propulsion during walking,” Journal of Biomechanics, vol. 42, no. 7, pp. 850–856, 2009.
[40]
K. K. Patterson, I. Parafianowicz, C. J. Danells et al., “Gait asymmetry in community-ambulating stroke survivors,” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 2, pp. 304–310, 2008.
[41]
B. French, L. H. Thomas, M. J. Leathley et al., “Repetitive task training for improving functional ability after stroke,” Stroke, vol. 40, no. 4, pp. e98–e99, 2009.
[42]
L. Wevers, I. van de Port, M. Vermue, G. Mead, and G. Kwakkel, “Effects of task-oriented circuit class training on walking competency after stroke: a systematic review,” Stroke, vol. 40, no. 7, pp. 2450–2459, 2009.
[43]
A. Lamontagne, C. Paquette, and J. Fung, “Stroke affects the coordination of gaze and posture during preplanned turns while walking,” Neurorehabilitation and Neural Repair, vol. 21, no. 1, pp. 62–67, 2007.
[44]
T. Imai, S. T. Moore, T. Raphan, and B. Cohen, “Interaction of the body, head, and eyes during walking and turning,” Experimental Brain Research, vol. 136, no. 1, pp. 1–18, 2001.
[45]
D. Xu, L. G. Carlton, and K. S. Rosengren, “Anticipatory postural adjustments for altering direction during walking,” Journal of Motor Behavior, vol. 36, no. 3, pp. 316–326, 2004.
[46]
A. E. Patla, A. Adkin, and T. Ballard, “Online steering: coordination and control of body center of mass, head and body reorientation,” Experimental Brain Research, vol. 129, no. 4, pp. 629–634, 1999.
[47]
M. S. Orendurff, A. D. Segal, J. S. Berge, K. C. Flick, D. Spanier, and G. K. Klute, “The kinematics and kinetics of turning: limb asymmetries associated with walking a circular path,” Gait & Posture, vol. 23, no. 1, pp. 106–111, 2006.
[48]
L. A. Simpson, W. C. Miller, and J. J. Eng, “Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke,” PLoS One, vol. 6, no. 4, Article ID e19431, 2011.
[49]
D. Hyndman, A. Ashburn, and E. Stack, “Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers,” Archives of Physical Medicine and Rehabilitation, vol. 83, no. 2, pp. 165–170, 2002.
[50]
R. G. Cumming and R. J. Klineberg, “Fall frequency and characteristics and the risk of hip fractures,” Journal of the American Geriatrics Society, vol. 42, no. 7, pp. 774–778, 1994.
[51]
S. F. H. Mackintosh, K. Hill, K. J. Dodd, P. Goldie, and E. Culham, “Falls and injury prevention should be part of every stroke rehabilitation plan,” Clinical Rehabilitation, vol. 19, no. 4, pp. 441–451, 2005.
[52]
M. T. Thigpen, K. E. Light, G. L. Creel, and S. M. Flynn, “Turning difficulty characteristics of adults aged 65 years or older,” Physical Therapy, vol. 80, no. 12, pp. 1174–1187, 2000.
[53]
K. Hase and R. B. Stein, “Turning strategies during human walking,” Journal of Neurophysiology, vol. 81, no. 6, pp. 2914–2922, 1999.
[54]
M. J. D. Taylor, P. Dabnichki, and S. C. Strike, “A three-dimensional biomechanical comparison between turning strategies during the stance phase of walking,” Human Movement Science, vol. 24, no. 4, pp. 558–573, 2005.
[55]
M. Roerdink, C. J. C. Lamoth, G. Kwakkel, P. C. W. van Wieringen, and P. J. Beek, “Gait coordination after stroke: Benefits of acoustically paced treadmill walking,” Physical Therapy, vol. 87, no. 8, pp. 1009–1022, 2007.
[56]
K. L. Hollands, M. A. Hollands, D. Zietz, A. Miles Wing, C. Wright, and P. van Vliet, “Kinematics of turning 180° during the timed up and go in stroke survivors with and without falls history,” Neurorehabilitation and Neural Repair, vol. 24, no. 4, pp. 358–367, 2010.
[57]
M. Hong, J. S. Perlmutter, and G. M. Earhart, “A kinematic and electromyographic analysis of turning in people with Parkinson disease,” Neurorehabilitation and Neural Repair, vol. 23, no. 2, pp. 166–176, 2009.
[58]
K. Berg, S. Wood-Dauphinee, and J. I. Williams, “The balance scale: reliability assessment with elderly residents and patients with an acute stroke,” Scandinavian Journal of Rehabilitation Medicine, vol. 27, no. 1, pp. 27–36, 1995.
[59]
C. Faria, L. F. Teixeira-Salmela, and S. Nadeau, “Effects of the direction of turning on the timed up & go test with stroke subjects,” Topics in Stroke Rehabilitation, vol. 16, no. 3, pp. 196–206, 2009.
[60]
M. E. Tinetti, T. Franklin Williams, and R. Mayewski, “Fall risk index for elderly patients based on number of chronic disabilities,” American Journal of Medicine, vol. 80, no. 3, pp. 429–434, 1986.
[61]
K. Berg, “Measuring balance in the elderly: preliminary development of an instrument,” Physiotherapy Canada, vol. 41, no. 6, pp. 304–311, 1989.
[62]
D. A. Winter, “Human balance and posture control during standing and walking,” Gait & Posture, vol. 3, no. 4, pp. 193–214, 1995.
[63]
A. D. Segal, M. S. Orendurff, J. M. Czerniecki, J. B. Shofer, and G. K. Klute, “Local dynamic stability in turning and straight-line gait,” Journal of Biomechanics, vol. 41, no. 7, pp. 1486–1493, 2008.
[64]
S. C. Strike and M. J. D. Taylor, “The temporal-spatial and ground reaction impulses of turning gait: Is turning symmetrical?” Gait & Posture, vol. 29, no. 4, pp. 597–602, 2009.
[65]
M. Woollacott and A. Shumway-Cook, “Attention and the control of posture and gait: a review of an emerging area of research,” Gait & Posture, vol. 16, no. 1, pp. 1–14, 2002.
[66]
H. Pashler, “Dual-task interference in simple tasks: data and theory,” Psychological Bulletin, vol. 116, no. 2, pp. 220–244, 1994.
[67]
L. Bensoussan, J. M. Viton, M. Schieppati et al., “Changes in postural control in hemiplegic patients after stroke performing a dual task,” Archives of Physical Medicine and Rehabilitation, vol. 88, no. 8, pp. 1009–1015, 2007.
[68]
D. Hyndman, R. M. Pickering, and A. Ashburn, “Reduced sway during dual task balance performance among people with stroke at 6 and 12 months after discharge from hospital,” Neurorehabilitation and Neural Repair, vol. 23, no. 8, pp. 847–854, 2009.
[69]
S. O'Shea, M. E. Morris, and R. Iansek, “Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks,” Physical Therapy, vol. 82, no. 9, pp. 888–897, 2002.
[70]
Y. R. Yang, Y. C. Chen, C. S. Lee, S. J. Cheng, and R. Y. Wang, “Dual-task-related gait changes in individuals with stroke,” Gait & Posture, vol. 25, no. 2, pp. 185–190, 2007.
[71]
I. Melzer, I. Tzedek, M. Or et al., “Speed of voluntary stepping in chronic stroke survivors under single- and dual-task conditions: a case-control study,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 6, pp. 927–933, 2009.
[72]
A. Bowen, R. Wenman, J. Mickelborough, J. Foster, E. Hill, and R. Tallis, “Dual-task effects of talking while walking on velocity and balance following a stroke,” Age and Ageing, vol. 30, no. 4, pp. 319–323, 2001.
[73]
P. Plummer-D'Amato, L. J. P. Altmann, D. Saracino, E. Fox, A. L. Behrman, and M. Marsiske, “Interactions between cognitive tasks and gait after stroke: a dual task study,” Gait & Posture, vol. 27, no. 4, pp. 683–688, 2008.
[74]
I. Melzer, M. Goldring, Y. Melzer, E. Green, and I. Tzedek, “Voluntary stepping behavior under single- and dual-task conditions in chronic stroke survivors: a comparison between the involved and uninvolved legs,” Journal of Electromyography and Kinesiology, vol. 20, no. 6, pp. 1082–1087, 2010.