Analysis of movements involved in raising lower garments during toileting in patients with stroke and hemiplegia: An analysis focused on manipulation on the paretic side.

Abstract

Movements to raise lower garments in patients with stroke and hemiplegia consist of downward reach, non-paretic-side manipulation, and paretic-side manipulation. In this study, we focused on paretic-side manipulation, which is particularly difficult, and investigated the factors that make it challenging. Forty-eight patients with stroke and hemiplegia (23 and 25 patients in independent and dependent groups, respectively) participated in this study. First, we investigated the difficulty of each manipulation using a visual analog scale to confirm the usefulness of focusing on paretic-side manipulation. Characteristics of the paretic side manipulation were compared between the dependent and independent groups using a three-dimensional motion analysis system. The dependent group showed greater difficulty in manipulation on the paretic side compared to manipulation on the non-paretic side. The dependent group had a lower paretic limb loading ratio (p < 0.01), greater pelvic rotation angle (p < 0.01), and longer paretic side manipulation time (p < 0.01) than those in the independent group. The factors that contributed to greater difficulty in manipulating the paretic side were a lower limb loading rate and larger pelvic rotation angle toward the paretic side. These factors make it difficult to reach the lower garment and result in inefficient manipulation of the paretic side.