Study on Movement Time of Individual After Stroke

Study on Movement age of Individual After cuffCase scenarioA 25 course old male change role who was app arntly sanitary 1 year ago when he met with an accident and got severe head injury, diagnosed with h hotshotst hemiplegia, was hospitalized for 1 month. Presently longanimous complains of, difficulty in getting up from hunch forward, and difficulty in walking. Patient has flexor synergy in Upper limb and extensor synergy is in dismantle limb, read-only storage and strength for right is decrease, tone for upper limb and lower limb is increased , grade3 on MAS , reflexes ar exaggerated. Presently, Patient is able to vex but only with support and need assistance in toileting and mobility. displayActivities of daily living is refers to those centripetal motor skills infallible for the practiseance of usual daily operation (1). These sensory motor skills under craft the business of daily self c atomic number 18 much(prenominal) as feeding, dressing, hygiene and phy sical mobility that are known as basic activities of daily living (1). each problem in playacting the ADL can affect personal social life (1),as well as community mobility. chance event is the sudden loss of neurological agency ca intaked by an interruption of blood flow to the brain (1). Stroke can be caused by m whatsoever reasons like traumatic, pathological etc. Post stroke uncomplaining deal with the variety of shortage like cognitive (1), sensory (3), motor (4), balance and coordination (5). All these components are necessary for the optimal carry throughance of any ADL (6). In girlish population ADL can be affected because of several reasons, but now a days most common problem which teenaged diligent are facing is stroke(6) which affect their ADL in terms of transferring like puzzle to live or delusion to devolve ons which is the basic activity in order to carry out any proletariat.In this teaching metre is measured for the individualistic to perpetrate a p articular activity. Time interpreted to come any labour measures several components like cognition (7), sensory (8), motor, balance and coordination (8). any deficit in any one or all the components leads to increase in the while interpreted to perform any activity (7) (8) (9).Any deficit in cognition uncomplaining give have difficulty in interpreting the subordination given to persevering which leads to increase in the clip interpreted to perform the task. Any motor deficit and sensory deficit can cause difficulty in moving limbs and awareness about the penchant of the limbs. Balance and coordination deficit leads to decrease postural control, all these components will hinder the long-suffering to perform the task at appropriate era (7) (8).Although there is no evidence or normative determine are yet described which tells about the linguistic rule term interpreted by an individual to perform sit to delusion and evasiveness to sit activity.In order to reconstruct t he persevering for sit to pillow and lie to sit task, it is in like manner necessary to see that at what degree of trunk modulation (0 or 45) and with which lieu of meat ( subordinate or non subordinate) it is easy for the patient to perform task which is measured in terms of clock interpreted by individuals to finish the task so that therapist can reconstruct the patient with lower limit difficulty.The normal timing taken by an individual to perform any task can be used both as a qualitative as well as quantitative. It helps to asses the various components of the deficit, and to rehabilitate the patients who have difficulty in playing ADL.Hence objective of this study is to measure the era taken to perform sit to lie and lie to sit activity at 0 and 45 of bed from low-level and non capable billet. This can be use to asses as well as rehabilitate the patient. pick up FOR STUDYStroke in the young is particularly debilitating as the patient wants to get integrate into the society as early as possible. Also a unique requirement for stroke in the young is that the expectations and the society needs are different from the olden when comparing community dwelling young adults vs. geriatric populations.There is no normative values are present in literature in order to keep out the usual cartridge clip taken by young individual to perform ADL. Sit to lie and lie to sit are basic bed mobility which patient with stroke broadly speaking encounter first. So in reference to these timing it is easy to asses as well as rehabilitate the patient in activities of daily living which is most important requirement of patients with stroke.LITERATURE REVIEWLindmark B ,Hanrin E ,Tornquist K in 1920 conducted study on 207 stroke patient, they were block outed after3 month and 1 year after the stroke, 183 survivors from the original population were assessed with standardized practical equipment which has 12 daily activities which is concerned with cognitive cistr on and coordination, hand function, mobility and balance . They did non find any significant leaving, reason out that there is no difference in the performance of daily activities at 3 month and1 year after stroke and too found out that women had more difficulty in performing compare to men in performing mobility task (6).Podsiodlo D , Richardson S , in 1991 conducted study on 60 elderly patient( entail age 79.5 years) to find out TUG as test for basic functional activity, time is metric for the patient to perform a rise from chair ,walk for 3 meters and then sit down again to perform a particular ADL, found out that TUG test is reliable and correlates well with berg balance denture and concluded that TUG test is reliable for evaluation of the ADL(10).Owsley C, Sloane M, Mc Gwin, Ball K. in 2001 conducted study on 173 older adults (65-90 yrs), which is large sample size in order to find out visual bear on speed and correlation mingled with memory and inductive reasoning wit h IADL ,time taken to perform the 5 IADL was calculated and found out that individual who have slow processing speed , takes more time to fulfill the task they concluded that cognition especially memory and reasoning are related to time taken to perform any ADL and it is utilizable in evaluating in cognition(8).Owsley, Cynthia, mcGWIN, Gerald Sloane, Michael E in 2001 conducted a study on 342 older adults who had visual impairment (58-86year) from eye clinic, to find out relation between visual function and time required to assoil the IADL, under visual impairment visual acuity, contrast sensitivity and useful field of view .17 IADL task which includes visual activity was evaluated with time taken. They concluded that visual function is necessary to achieve any ADL (9).Hsieh CL ,Shen CF,Hsueh IP, Wang CH in 2002 conducted a prospective study was on 169 stroke patient to find out relation between trunk control and ADL in early stage in stroke patient after6 month of stroke, postur al assessment scale for stroke patient scale(PASS-TC) fugl meyer motor test and balance test was used to asses motor and balance gazeively, patients were assessed at 14thday after stroke and 6 month. They concluded that trunk control is related to comprehensive ADL(11).Gregory T, Cullaghan A, Nettelback T ,Wilson C in 2009 conducted study on elderly people to examine whether early inspection time forecast future problem in ADL , actor completed IT at service line, 6 month,18 month and at 14 month after stroke, 2 company of 15 elderly with aged (74-88 years) are assessed for timed IADL, it shows that group with slower IT had poorer performance (took longer time to finish task)on more than half of the functional activity and concluded that slower IT shows difficulty in performing functional activity(12).Emma Barry, Rose Galvin, Claire Keogh, Frances Horgan and Tom Fahey in 2014 did a systemic review and metanalysis to find TUG is a predictor of risk of fall in older adult, a liter ature search of 25 in systemic review and 10 in metanalysis was do and TUG score 13.5 sec was used to identify individual with high risk of falling and found out that TUG test has limited ability to predict to predict risk of fall in elderly (13).METHODOLOGYStudy design Cross- sectional study a pilot studySample size n=30(50% male and 50% female)Type of sampling convenience samplingSource of data collection M.S. Ramaiah Medical College, Department of Physiotherapy.METHOD OF DATA arrayA cross- sectional study design was undertaken for the study.Young adult aged between 20 25 years fulfilling in M.S. Ramaiah medical college, department of physiotherapy were included in study. Convenience sampling was done and sample of 30 subjects were included in the study. Informed consent of all the 30 subjects are taken prior to undertaking the study and procedure was explained to them.Inclusion criteriaMentioned conditions directly affect the time taken to perform a particular task. cognitio n is tested by checking memory reasoning and intelligence.1. Aged between 20-25 years.2. takings should not have any pain, trauma, inflammation, fracture etc by history /reported.3. Should not have any cognitive deficit.4. Should have competed consent form.Exclusion criteria in a higher place mentioned condition can interfere in test and also affect the time taken to perform thegiven task.Any reported trauma, inflammation, pain in lower back and lower limbs.History of Low back pain, knee pain.Intake of alcohol in brook 24 hrs.Any history of hypotension while performing ADL.Any giddiness while performing IADL tasksAny cognitive or higher mental funti0n deficit.Materials used for the studyStop watchAdjustable libertine hurlHeight scaleWeighing machineTest procedureDemographic data of young adult was noted, including height, weight, gender etc. subjects to be tested was explained about the procedure of the test. Subjects are asked to sit at edge of bed. When start command was given , the subject had to lie down according to given instruction by using preferable speed to perform the activity, time taken for the subject to perform the sit to lie and lie to sit was noted down.Both these activities were performed at 0 and 45 of elevation of bed end, from dependent side as well as from independent side of elevation of bed end.Starting positions seance Position neck straight, head in midline, spine erect, Hands on a side, knee and hep at 90, substructure unsupported.Lying position straight, head in midline, hands on sides, legs together, foot in a neutral positionTask was observed from standing in front of patient. The identical procedure was repeated and time is taken for 30 subjects, to find out normal value to perform sit to lie and lie to sit in young adult.Picture 1a Firm and adjustable couch at 00. Picture1b Firm and adjustable couchat 450. experience 2a Starting position at 00 PICTURE 2b Starting position at00(side view).Picture 3 Starting position at 450P ICTURE 4a nett position of sit to lie at 00PICTURE 4b Final position of lie to sit 45Picture5 During testData AnalysisStatistical analysis Microsoft word and Excel were used to generate data and graphs.Statistical Tests mean, mode, median of time taken to perform the sit to lie and lie to sit activity was calculated for 30 subjects. Mean is taken to as come time taken to perform the task. t test was done to compare the values of sit to lie and lie to sit from dependent and non dependent at 0 and 45.RESULTA cross sectional study consisting of 30 normal healthy young adult is taken to find out the normal time taken by younger individual to perform sit to lie and lie to sit at 00and 450from dependent and non dependent side.This graph is showing average time taken to perform sit to lie and lie to sit. The values of sit to lie and lie to sit which are not showing any statistical importation depending on different side and angle of trunk flexion. circuit card2 t and p value of the aver age of time taken to perform sit to lie and lie to sit.t- scorep-scoreSit to lieND(00) vs. ND(450)0.7040.483D(00) vs. ND(450)1.0100.318ND(00) vs. D(450)-1.0470.299D(00) vs. D(450)1.3550.180ND(0) vs. D(0)-0.4090.683ND(45) vs. D(45)0.7040.483 lie in to sitND(00) vs. ND(450)1.6330.107D(00) vs. ND(450)1.1700.246ND(00) vs. D(450)1.5810.119D(00) vs. D(450)1.1040.273ND(00) vs. D(00)0.4880.626ND(450) vs. D(450)-0.1160.907Sit to lie vs. untruth to sitND(00) vs. ND(00)0.0270.978D(00) vs. D(00)0.9330.354ND(450) vs. ND(450)1.1600.250D(450) vs. D(450)0.9470.347Table2 the t value and p value are showed non of the data have p value Table 3 equation between 00 and 450 in sit to lie and lie to sit.00450Sit to lieND (3.497)ND(3.366)D(3.565)ND(3.366)ND(3.497)D(3.321)D(3.565)D(3.216)Lie to sitND(3.491)D(3.156)D(3.375)ND(3.136)D(3.345)D(3.156)ND(3.491)ND(3.156)Above table is showing the par between average time taken at 00 and 450. There is not significant difference between the time taken by subject in sit to lie and lie to sit from 00and 450.Figure2a 00 vs. 450 from sit to lie Figure2b 00 vs. 450 from lie to sitGiven figure 2a is showing comparison of mean time taken to sit to lie from 00 and 450 which is not statistically significant(pTable 4 Comparison between the averages of time taken from dependent vs. non dependent side.Non low-levelSide (sec)Dependent(sec)Sit to lie 450(3.366)450(3.321)00(3.497)450(3.321)450(3.366)00(3.565)00(3.497)00(3.565)Lie to Sit450(3.136)450(3.156)00(3.491)450(3.156)450(3.136)00(3.375)00(3.491)00(3.375)This table presents the comparison between dependent vs. non dependent side from sit to lie and lie , average mean of the sit to lie and lie to sit are statistically not significant , P 0.05 , hence no suitable value can be concluded from this present data.Figure3a Dependent vs. Non Dependent Figure3b Dependent vs. Non Dependentfrom sit to lie. from lie to sitGiven fig 3a is showing the comparison between dependent vs. non dependent from sit to lie and fig3b. From, the t scores of these data is not showing any statistical conditional relation (p0.05).Table 5 Comparison between average time taken in sit to lie vs. lie to sit.Sit to lie vs. lie to sitSit to lie in (sec)Lie to sit in (sec)Nondependent (00)3.4973.491Dependent(00)3.5653.375Nondependent(450)3.3663.136Dependent(450)3.3213.156This table presents the comparison between the average time taken from sit to lie vs. lie to sit. statistically these values are not significant (p0.05).Figure 4 comparison between time taken from sit to lie vs. lie to sitFigure 4 showing the comparison between the time taken from sit to lie vs. lie to sit which is statistically not significant hence is not showing any difference in time taken to perform both these activities.TABLE 6 Average of mean value for sit to lie and lie to sit from dependent and non dependent side at 00 and 450Mean valuesSit to lieNon Dependent(0)3.50Dependent(0)3.57Non Dependent(45)3.37Dependent(45)3.32Lie to sitNon De pendent(0)3.49Dependent(0)3.37Non Dependent(45)3.14Dependent(45)3.16Average3.36In table6, the average of all mean time taken to perform sit to lie and lie to sit, as it is not any statistical significance ,so there is no difference in time taken to perform this task.DISCUSSIONThe time taken by young adult (20-25 years) to perform sit to lie and lie to sit from dependent and non dependent side at 00 and 450 of trunk flexion has done to find out the normal time taken by young adult to perform this particular activity. This activity is a basic mobility which the stroke patient encounter first and also find difficult to do. Timing of these activity measures cognition, sensory, motor, balance and coordination component of the patient which will help to find out the level of functional activity in reference to the time taken to contact the given activity.Activity was measured at different angle of trunk flexion (00 and 450) a well as from different side (dependent and non dependent). Bef ore the study it was assumed that from dependent side it is easy to accomplish the task, as well as from 450 it is easy to lie down as well as get up as therefore should take less time to finish the task, as at 450 the length tension relationship is good and it provide extra leverage to come against gravity, in 450 as the muscle is in tension, muscle fiber recruitment is more. Getting up from dependent side was hypothesized to be easier as compare to nondependent. It was also assumed that as sit to lie and lie to sit are two different activities so time taken to perform both these activity will be different.In our study, on analyzing the result of table 2 ( t test of the average of the time taken to perform the sit to lie and lie to sit at different plane) is observed that p-value of mean score of time taken to perform sit to lie and lie to sit is statistically not significant. Values at different plane is statistically not significant that may be because of the excellent sample s ize as well as population age. Good strength in muscles, balance and coordination in limbs helps to overcome the gravity easily. The t score and p- value for the comparison of sit to lie and lie to sit is also statistically not significant. Since all comparisons were statistically insignificant, we averaged the mean for condition The average for the sit to lie and lie to sit was found to be 3.36 sec.In order to asses and rehabilitate the stroke patient timed ADL will asses several components in one time. In order to asses the patient who has difficulty in basic mobility like sit to lie or lie to sit can be assessed with respect to time taken to accomplish that activity , any increase in time taken to accomplish the particular activity may suggest need for intervention , and patient can be instruct for the same activity for time taken. Time taken can evaluate contribution from different components such as cognition, strength, balance, coordination. Therefore assessing time may help the therapist to quantify these components and give direction to treatment. thence concluded that sit to lie and lie to sit takes same time irrespective of overabundant and non dominant side, and angle of trunk flexion (00 and 450). The average time to perform sit to lie or lie to sit for young adult is 3.36 sec.CONCLUSIONFrom the present study we can conclude that the average time taken to perform the sit to lie and lie to sit activity is 3.36. The time taken to perform sit to lie and lie to sit from dependent and non dependent side at 00 and 450 was the same. It did not differ with the side as well as the angle of trunk flexion. Limitation of the StudyVideo for the task is not taken which can help to evaluate the different components of task and may be cooperative to explain the reason behind the variation in timing in different individual.Instruction to use a preferable speed may not reliable for every patient.The sample size is humble and taken for only 20-25 year old young adult.Clinical ImplicationAs the time taken to perform sit to lie or lie to sit is 3.36 sec, and in my case scenario patient is 25 year old and has difficulty in bed mobility we can take it (3.36 sec) as a baseline in order to asses and rehabilitate the patient . We can measure the time taken by a patient to complete sit to lie and can further retrain the patient to complete the tasks inwardly 3.36 sec this will help the patient to achieve the status of community functional mobility. It will help us to plan a treatment parameter such as time taken to complete and components of sit to lie as an outcome measure. So in this case summary we could set a goal of 3.36 sec as the time required to achieve functional mobility.