Effects of Flexion and Extension Type Arm Slings on Walking Kinematics and Balance in Stroke Patients

Stroke is one of the most common diseases in the world, affecting one in every four people (Campbell & Khatri, 2020). After stroke, approximately 80% of patients experience walking disorders (Algurén et al., 2010). Stroke survivors demonstrate gait disturbances such as reduced walking speed, step length and cadence (Balaban & Tok, 2014). Deterioration in walking kinematics negatively affects daily living activities, confidence, self-care, social roles, family life and reducing quality of life in stroke survivors (Park & Kim, 2019). Additionally, walking disturbances in stoke patients can lead to increased energy expenditure, pain and risk of falling (Balaban & Tok, 2014; Shin et al., 2020). Besides, balance impairments are frequent clinical symptom in stroke survivors. Compared to healthy individuals, stroke patients have lower balance and walking capacity. Accordingly, the risk of falling increases, physical activity and participation reduces in individuals with stroke (Roelofs et al., 2023). Therefore, it is important that walking kinematics and balance in stroke survivors should have similar characteristics to the healthy individuals.

One of the frequently complications after stroke is shoulder subluxations. Shoulder subluxation increases the distance between the acromion and the humeral head, thus delay improvement of upper extremity motor function and decrease proprioception in stroke survivors (Paci et al., 2005). Electrical stimulation, robot-assisted upper extremity rehabilitation and arm slings are the physiotherapy and rehabilitation applications used to prevent shoulder subluxations in stroke patients (Jung & Choi, 2019; Paci et al., 2005). Arm slings are often used to help reposition the humeral head in the glenoid fossa by counteracting gravity on the affected side (Jeong et al., 2022). In addition, it has been stated that arm slings have a positive effect on balance, increase walking efficiency, reduce spasticity and are a painless application in stroke survivors (Acar & Karatas, 2010; Jeong et al., 2022). In the clinic, it has been observed that stroke patients use flexor or extensor type arm slings. However, no study has been found investigating the effects of these different types of arm slings on walking kinematics and balance in stroke patients. The aim of the presented study is to investigate different types of arm slings on walking kinematics and balance in stroke patients and compare with the healthy individuals.

Inclusion criteria

• Inclusion criteria for EG were: (1) stroke diagnosis, (2) age 18-80, (3) independent ambulation (Functional Ambulation Category-FAS ≥ 2), (4) Modified Ashworth Scale-MAS ≤2 for gastrocnemius and biceps muscles, (5) ability to walk 10 m independently or with assistive device, (6) physician approval for an exercise program.
• Inclusion criteria for CG: (1) healthy individuals without any additional neurological or orthopaedic diseases that may affect balance and gait, (2) age 18-80, (3) physician approval for an exercise program.

Exclusion criteria

• (1) severe visual impairments, (2) cerebellar involvement, (3) upper extremity Brunnstrom stage ≤ 3, (4) cancer diagnosis, (5) presence of a neurological or orthopedic condition other than stroke, (6) inability to understand and follow commands or lack of cooperation.