Introduction: Making turn is a challenging task that is reported as one of the activities that most frequently leads to fall in stroke patients. Among community-dwelling older adults, hip fractures are eight times more likely to result from falls while making turns than from falls while walking straight. The stroke patients have asymmetric posture and movements due to hemiparesis, thus their turning performance may varied depending on the direction of the turn. Therefore, the purpose of this systematic review was to summarize the characteristics of turning after stroke and discuss the possible neuromuscular mechanisms of turning difficulties. Methods: Searches of electronic databases including CINAHL, Medline, and PsycINFO were undertaken using the search terms: ＂turn＂ and ＂stroke.＂ The selection criteria for the literature were that the article was original, written in English and that the full text of the article was available. Results: We included 11 papers and 277 stroke patients in this systematic review. The literature indicated that individuals with stroke required greater number of steps, longer time, and worse quality to complete a turn. The sequential initiation of body segments showed significant delay compared to healthy individuals. Also, their center of gravity displacements in medial-lateral directions were smaller and slower within their base of support. They had longer total trajectories of turning and significant deviations from the reference trajectories of healthy subjects. Turning strategies were different between turning directions with reduced stability of the affected leg when the turn was made toward the affected side. By contrast, there was a dragging foot, insufficient hip and knee flexion and rigid intersegment body rotation when the turn was towards the unaffected side. However, similar turn times and number of steps were found in both turning directions. The possible neuromuscular mechanisms of turning difficulties could be related to axial or leg impairments. Axial impairments include increased postural muscle tone, rigid axial trunk, and decreased intersegmental flexibility. Leg impairments include muscle weakness, instability, and an increased extensor synergy pattern of the affected lower limb. Conclusions: The use of a greater number of steps, taking longer time to complete the turn, and the poor quality of the turn indicate turning difficulty in stroke individuals. However, this could be a compensatory or adaptative strategy to maintain balance during the turn. This systematic review provides clinicians a better understanding of turn difficulty after stroke, and the criteria to identify potential stroke patients with high risks of dysfunctional turning. In addition, healthcare professionals could evaluate turning ability by investigating turn time, the number of steps taken, and turn quality during routine assessment in order to identify turning difficulty in stroke patients. This assessment may offer the opprtunity to provide patients with tailored rehabilitation or exercise intervention to improve turning performance and decrease the risk of falling.
- systematic review