Abstract
Objective
To determine the validity of the Trunk Impairment Classification system (TIC) with
4 possible scores (0, most impaired; 0.5; 1.0; 1.5, least impaired) in relation to
objective, instrumented measures of impairment.
Design
Cross-sectional design.
Setting
National wheelchair rugby and basketball competitions of The Netherlands and Belgium.
Participants
Volunteer sample of athletes (N=34) with a minimum of 1-year experience in their sport.
Interventions
Static sitting balance tasks on a stable and unstable surface; dynamic sitting balance
tasks in anterior-posterior, left-right, and oblique directions; and trunk muscle
strength tasks in forward, left, right, and backward directions.
Main Outcome Measures
Sway area of the center of pressure in static sitting balance, maximum excursion of
center of pressure displacement in dynamic sitting balance, and maximum isometric
force in trunk muscle strength.
Results
Athletes with TIC score 0 were not able to sit unsupported. The Kruskal-Wallis test
showed a significant difference in trunk muscle strength (P<.001) and dynamic balance in the oblique direction forward to the left and backward
to the right between the TIC scores (P=.012). Post hoc analysis showed a significant difference between TIC score 0 and
the other TIC scores for trunk muscle strength in all directions. There was a significant
difference between TIC score 1.5 on one hand and TIC scores 0.5 and 1.0 on the other
hand for dynamic balance in the right oblique direction.
Conclusions
The TIC is a valid scale for trunk impairment, which measures neuromusculoskeletal
trunk impairment, independent of the health condition causing the impairment. Additional
research is needed for coordination impairment and to assess whether TIC scores 0.5
and 1.0 should continue as separate scores.
Keywords
List of abbreviations:
COP (center of pressure), ICC (intraclass correlation coefficient), ROM (range of movement), TIC (Trunk Impairment Classification system)To read this article in full you will need to make a payment
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References
- The relationship between sitting stability and functional performance in patients with paraplegia.Arch Phys Med Rehabil. 2003; 84: 1276-1281
- Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting.Gait Posture. 1999; 10: 135-146
- Sitting balance II: reach direction and thigh support affect the contribution of the lower limbs when reaching beyond arm’s length in sitting.Gait Posture. 1999; 10: 147-153
- Validity and reliability of assessment tools for measuring unsupported sitting in people with spinal cord injury.Arch Phys Med Rehabil. 2009; 90: 1571-1577
- Seated reach distance and trunk excursion accurately reflect dynamic postural control in individuals with motor-incomplete spinal cord injury.Spinal Cord. 2010; 48: 745-749
- Training unsupported sitting in people with spinal cord injuries: a randomized controlled trial.Spinal Cord. 2010; 48: 138-143
- Adaptation of computerized posturography to assess seated balance in persons with spinal cord injury.J Spinal Cord Med. 2013; 36: 127-133
- Comparison of multidirectional seated postural stability between individuals with spinal cord injury and able-bodied individuals.J Rehabil Med. 2013; 45: 47-54
- Which trunk inclination directions best predict multidirectional-seated limits of stability among individuals with spinal cord injury?.J Spinal Cord Med. 2012; 35: 343-350
- Achieving functional independence.in: Braddom R.L. Physical medicine and rehabilitation. Saunders, Philadelphia2011: 565-579
- International standards for neurological classification of spinal cord injury (revised 2011).J Spinal Cord Med. 2011; 34: 535-546
- Clinical characteristics of impaired trunk control in children with spastic cerebral palsy.Res Dev Disabil. 2013; 34: 327-334
- A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale.Res Dev Disabil. 2011; 32: 2624-2635
- Trunk performance after stroke: an eye-catching predictor of functional outcome.J Neurol Neurosurg Psychiatry. 2007; 78: 694-698
- The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke.Clin Rehabil. 2004; 18: 326-433
- Assessing motor impairment of the trunk in patients with traumatic brain injury: reliability and validity of the Trunk Impairment Scale.S Afr J Physiother. 2006; 62: 23-28
- Reliability and validity of trunk assessment for people with multiple sclerosis.Phys Ther. 2006; 86: 66-76
- The effect of footrest on sitting balance in paraplegic subjects.Arch Phys Med Rehabil. 2002; 83: 642-648
- Motor preparation in postural control in seated spinal cord injured people.Ergonomics. 2001; 44: 457-472
- Impaired balance control in paraplegic subjects.J Electromyogr Kinesiol. 1997; 7: 149-160
- Center-of-pressure displacement during postural changes in relation to pressure ulcers in spinal cord injured patients.Am J Phys Med Rehabil. 2008; 87: 177-182
- International Paralympic Committee position stand—background and scientific rationale for classification in Paralympic sport.Br J Sports Med. 2011; 45: 259-269
- Persons with lower-limb amputation have impaired trunk postural control while maintaining seated balance.Gait Posture. 2013; 38: 438-442
- Sitting balance and trunk muscle strength in paraplegic patients.J Phys Ther Sci. 1995; 7: 77-83
World Health Organization. International Classification of Functioning, Disability and Health. Available at: http://www.who.int/classification/icf/en/. Accessed March 19, 2015.
- International Paralympic Committee (IPC). IPC Classification Code and International Standards.(Available at:) (Accessed March 19, 2015)
- Reliability of the revised wheelchair rugby trunk impairment classification system.Spinal Cord. 2013; 51: 913-918
- Paralympic classification: conceptual basis, current methods, and research update.PM R. 2014; 6: S11-S17
- Motor control, translating research into clinical practise.Lippincott Williams & Wilkins, Baltimore2007
- Quantitative analysis of the limits of stability in sitting.J Appl Biomech. 2010; 26: 265-272
- Sitting balance and limits of stability in persons with paraplegia.Spinal Cord. 2013; 51: 267-272
- Posturographic assessment of sitting balance recovery in the subacute phase of stroke.Gait Posture. 2008; 28: 507-512
- Functional reach in wheelchair users: the effects of trunk and lower extremity stabilization.Arch Phys Med Rehabil. 1995; 76: 360-367
- Trunk strength effect on track wheelchair start: implications for classification.Med Sci Sports Exerc. 2011; 43: 2344-2351
International Wheelchair Rugby Federation. IWRF classification manual. 3rd ed. Appendix C: trunk test flow chart. Appendix D: description of trunk tests. January 2015. p 77-82. Available at: http://www.iwrf.com/resources/iwrf_docs/IWRF_Classification_Manual_3rd_Edition_rev-2015_(English).pdf. Accessed March 19, 2015.
World Medical Association. Declaration of Helsinki, October 2008. Available at: http://www.wma.net/en/30publications/10policies/b3/17c.pdf, Accessed March 19, 2015.
- A new method of statokinesigram area measurement. Application of a statistically calculated ellipse.in: Igarashi M. Black F.O. Vestibular and visual control on posture and locomotor equilibrium. Karger, Basel1985: 74-79
- The measurements of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Anatomical data for analyzing human motion.Res Q Exerc Sport. 1983; 54: 169-178
Altmann VC, Hart A, Parkinson A. Wheelchair rugby classification database: aid to the improvement of classification. In: Proceedings of the Fourth IPC Vista Conference. Classification: solutions for the future. International Paralympic Committee; 2006 May 6-7; Bonn (Germany). CD ROM; 2006.
- Postural motor programming in paraplegic patients during rehabilitation.Ergonomics. 1998; 42: 302-316
- Development of new muscle synergies in postural control in spinal cord injured subjects.J Electromyogr Kinesiol. 1998; 8: 23-34
- Relative contribution of motor impairments to limitations in activity and restrictions in participation in adults with hemiplegic cerebral palsy.Clin Rehabil. 2010; 24: 454-462
Article info
Publication history
Published online: November 06, 2015
Footnotes
Current affiliation for Groenen, Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, Nijmegen, The Netherlands, and for van Limbeek, Achmea Healthcare, Amersfoort, The Netherlands.
Federation for Disability Sports in The Netherlands and Hollister, The Netherlands, contributed to the travel costs of the participants but had no part in the study/testing itself.
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
