Evidence - WTT - STS

Question 1

Nuzik et al, 1986

Answer 1

• Healthy population STS kinematics
• movement duration for standing up - 1.5 s
• COM moves in 2 phases: horizontal then vertical
• ankles at 15 deg DF, thigh off at 30% mvmt, knees move forward then back to start postion

Question 2

Shepherd and Gentile, 1994 found…

Answer 2

• compared active trunk inclination vs no trunk inclination
• at thigh off force through feet is 150% BW
• max force in all mm had to be sustained over a longer period of time when no forward trunk inclination
• Clinical implications: 75% BW loading required through each foot. Poor trunk inclination reduces mvmt efficiency

Question 3

Khemiani et al, 1998

Answer 3

• Ankle DF are active before the mvmt begins
• mm that propel body upward active before thighs off
• Clinical implications: whole task training engages multiple muscle groups at different times

Question 4

Shepherd and Koh, 1996

Answer 4

• Examined 3 foot positions
• further the feet are forward the greater distance body mass needs to move, movement time increases, hip moment increase, knee and ankle moments decrease
• Clinical implications: Feet too far forward = inefficient mvmt pattern

Question 5

Brunt et al, 2002

Answer 5

• Effects of 3 different foot positions: normal, unaffected extended and unaffected elevated in stroke pts
• Peak vertical force trhough affected foot greater when unaffeced foot forward and elevated. Rate of development of force greater in affected foot when unaffected foot forward or elevated
• Place unaffected foot forward, or elevate to increase loading on affected leg

Question 6

Arborelius et al, 1992

Answer 6

Examined effects of standing up in different conitions

• seat at knee height, seat at knee height with use of arms, seat at knee height & 1/3 thigh length, seat at knee height & 2/3 thigh length
• movements aroun knee and hip decrease as seat height increased
• muscle activity decrease

Question 7

Pollack et al, 2014

Answer 7

• Systematic review of 13 studies looking at the effect of interventions training STS in people with stroke.
• repetitive STS practice
• 30-60 min sessions, 3.5 x per week, 2-12 weeks
• STS interventions have beneficial effect on time take to STS and lateral symmetry during STS
• Improvements maintained at follow up
• Clinical implications: STS X’s improve wt distribution and improve task ability

Question 8

Engardt et al, 1993

Answer 8

• trainined standing up with auditory feedback. 45 mins, 5 days/ week 6 weeks
• improvement in WI, distribution both standing up and sitting down (13% compared with 5%)

Question 9

Stanton et al, 2017

Answer 9

• Review of RCT looking at effect of biofeedback on low limb activities after stroke
• biofeedback and physio tended to improve standing up more than physio alone
• Clinical implications: include feedback in treatment

Question 10

Stanton et al, 2016

Answer 10

• Feasibility of using square rule to provide feedback on foot position in prep for standing up. No verbal feedback provided
• Participants were able to stand up more quickly, with improved quality
• Clinical implications: Square rule effective for training STS