The relationship between pelvic alignment and trunk control in stroke subjects: a cross-sectional study

Shivani Pathak, Vijaya Kumar K, Akshatha Nayak, Rakshith C. Kedambadi


Background: Following stroke static as well as dynamic components of postural control were affected. Ability to maintain postural alignment is also a vital component of the postural control system. Pelvic asymmetry is commonly observed in stroke subjects which can influence trunk control. However, there is a paucity of literature that determines the relationship between pelvic alignment and trunk control in subjects with stroke.

Aim: To analyze the relationship between pelvic alignments using PALM and trunk control as measured by the Trunk Impairment Scale (TIS).

Setting: Inpatient rehabilitation unit, Tertiary Care Hospitals, Mangalore.

Design: A cross-sectional study.

Subjects: 38 supra-tentorial stroke subjects with more than 3 weeks duration and who can be able to sit independently were recruited.

Methods: The medio-lateral pelvic alignment of the stroke subjects was measured in sitting using the PALM™. The deviation in the pelvic tilt on the paretic side in comparison to the non-paretic side was measured in degrees. Following which the trunk control was evaluated using the Trunk Impairment Scale.

Results: The correlation between the pelvic tilt and the trunk control in the stroke subjects showed a negative correlation which indicates that a change in the pelvic alignment which affects the trunk control. Pelvic tilt values negatively correlated with all the sub-items of trunk impairment scores (p < 0.00). The pelvic tilt and the items of TIS scores. Brunnstrom’s stage of lower extremity Motor Recovery demonstrated a significant association (p < 0.05), except for the coordination sub score of the TIS.

Conclusion: Pelvic alignment influences the trunk control and is also available to be associated significantly with the acute phase of stroke (3 weeks to 3 months). Brunnstrom’s Stage of lower extremity motor recovery is also associated significantly with the static and dynamic sub scores of the TIS, hence trunk control may influence extremity motor recovery.



Stroke, Trunk control, Pelvic Alignment, Sitting balance

Full Text:



Mishra NK, Khadilkar SV. Stroke Programme of India. Ann Indian Acad Neurol 2010; 13: 28–32.

Banerjee T, Kumar S. Epidemiology of stroke in India. Neurology Asia 2006; 11:1-4.

Ryerson S, Byl NN, Brown DA, Brown D, Wong R and Hidler J. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol PhysTher 2008; 32: 14–20.

Verheyden G, Niewbouer A, Vereeck L ,Steven T, Mark T, Herregodts,et al. Trunk Performance After Stroke And Its Relationship With Balance, Gait And Functional Activity. Clin Rehabil 2006; 20:451-8.

Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke 2002; 33: 2626-30.

Bohannon RW. Lateral trunk flexion strength: impairment, measurement reliability and implications following unilateral brain lesion. Int J Rehabil Res 1992; 15: 249-51.

Tanaka S, Hachisuka K, Ogata H. Trunk rotatory muscle performance in post-stroke hemiplegic patients. Am J Phys Med Rehabil 1997; 76:366-9.

Tanaka S, Hachisuka K, Ogata H. Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients. Am J Phys Med Rehabil 1998; 77:288-90.

Messier S, Bourbonnains D, Desrosiers J, Roy Y. Dynamic Analysis of Trunk Flexion after Stroke. Arch Phys Med Rehabil 2004; 85(10):1619-24.

Ryerson Sd. Movement Dysfunction Associated with Hemiplegia. Umphred’s Neurological Rehabilitation 6th edition USA, Mosby Elsevier; 2007 p.626-27.

Tyson SF. Trunk kinematics in hemiparetic gait and the effect of walking aids. Clin Rehabil 1999; 13:295-300.

Vrtovec T, Janssen MMA, Likar B, Castelein R, Viergever M and Pernus F. A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment. The Spine 2012; 12(5):433-46.

Petrone MR, Guinn J, et al. The Accuracy Of The Palpation Meter(PALM) For Measuring Pelvic Crest Height Difference And Leg Length Discrepancy. J Orthop Sports Phys Ther 2003; 33:319-25.

Hagins, Marshall Brown, Martha Cook, Clare Gstalder, Karen Kam, Michael Kominer, Gene Strimbeck, Katesel.Intratester and Intratester Reliability of The Palpation Meter (PALM) In Measuring Pelvic Position. J. Man Manip Ther 1998; 6 (3):130-36.

Davies PM. Right in the Middle. Selective Trunk Activity in the treatment of Adult Hemiplegia, India: Springer (India) Private Limited; 2003 p34-35.

Verheyden G., Niewbouer A., Ann Van De Winckel, Willy De Weerdt. Clinical Tools to Measure Trunk Performance after Stroke: A Systematic Review of Literature. Clin Rehabil 2007; 21:387-94.

Verheyden G., Niewbouer A., Mertin J. ,Peger E, Kiekens C. TheTrunk Impairment Scale: A New Tool To Measure Motor Impairment Of The Trunk After Stroke. Clin Rehabil 2004; 18:326-34.

Yahia Zakaria, Usama Rashad. Assessment of Malalignment of Trunk and Pelvis in Stroke Patients.Egypt J Neurol Psychiat Neurosurg 2010; 47 (4): 599-604.

Verheyden G, Van Duijuhoven, Burnett M, Littlewood J, Kunkel D, Ashburn AM. Kinematic Analysis of Head, Trunk and Pelvis Movement With People Early After Stroke Reach Sideways. Neuro rehabil Neural Repair 2011; 7: 656-63.

Lee D. The Pelvic Girdle. Edinburgh: Churchill Livingstone; 1989.p86-90.

Preuss RA, Grenier SG, McGill SM. Postural control of the lumbar spine in unstable sitting. Arch Phys Med Rehabil. 2005; 86: 2309-15.

Hun SY, Doo SP. The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients. J Exerc Rehabil 2013; 9(3):362-67.

Feigin L, Sharon B, Czaczkes B, Rosin AJ. Sitting equilibrium 2 weeks after a stroke can predict the walking ability after 6 months. Gerontology 1996; 42:348-53.

Isle JW, Nienhus B, Latour H, Geurts A. Posturographic assessment of sitting balance recovery in sub-acute phase of stroke. Gait Posture 2008; 28: 507-12.

Bujanda DE., Sylvie N., Daniel B., Dickstein Ruth. Associations between lower limb impairments, locomotor capacities and kinematic variables in the frontal plane during walking in adults with chronic stroke. J Rehabil Med 2003; 35: 259–64.

Karthikbabu S., Nayak Akshatha., K Vijayakumar., Misri Z K., BV Suresh., Ganesan Sailaxmi., Joshua Abraham M. Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial. Clin Rehabil 2011; 25(8): 709–719.

Ryerson S and Levit K. Functional movement: A practical model for treatment. Functional movement reeducation: a contemporary model for stroke rehabilitation.Edinburgh: Churchill Livingstone, 1997, pp.1–14.

Verheyden G, Nieuwboer A.,Wit L, Thijs V, Dobbelaere J., Devos H., Severijns D. Time Course of Trunk, Arm, Leg, and Functional Recovery After Ischemic Stroke. Neurorehabil Neural Repair 2008; 22:173-9.