altered pelvic alignment and asymmetrical weight bearing onto lower limbs are the most common findings observed after stroke . ability to transfer weight on paralyzed lower extremity is a prerequisite for functional mobility skills such as rising from a chair , reach - outs in standing and walking . perceptual dysfunction , sensory loss , poor motor recovery of lower extremity , spasticity , muscular weakness , poor trunk control , and altered pelvic alignment could contribute for reduced weight acceptance on the most affected lower limb . altered pelvic alignment due to poor trunk - pelvis dissociation or reduced hip muscular control acting around pelvis may account for asymmetric weight distribution onto most affected lower limb during gait in people with stroke . it is believed that trunk muscular control at pelvis is the key contributing factor for balance ability , walking , and function after stroke . the trunk muscles attached to pelvis provide core stability which is an essential component for normal postural alignment of the pelvis . external oblique muscle , the largest muscle of abdomen , is responsible for core stability and forward tilting of the pelvis . after stroke , the impairment of lower abdominal activity shall fix the pelvis tilted posteriorly in sitting , thus providing passive stability during upper trunk initiated forward movements . furthermore , the pelvis was more oriented toward the most affected side in sitting , and this lateral pelvic tilt was correlated to poor trunk control . people who had excessive lateral pelvic tilt in sitting as measured by palpation ( palm ) meter present with poor dynamic sitting balance and worse lower limb motor recovery . likewise , photogrammetry method showed a strong relationship between the postural alignment of the pelvis in sitting and seated postural control early after stroke . although the pelvic instability poststroke is one of the attributes to weight - bearing asymmetry ( wba ) , how the altered pelvic tilt in standing affects the wba is understudied . hence , we attempted to test the pelvic tilt and its relationship to wba in community - dwelling stroke survivors . this cross - sectional study was approved by the research and ethics committee of manipal university , manipal . community - dwelling chronic stroke survivors were recruited from two tertiary care rehabilitation centers and rural settings between june 2011 and may 2015 . they were explained about the study procedure , and informed consent was obtained from them seeking their voluntary participation in the study . the inclusion criteria of the study were as follows : people with first - ever stroke , unilateral supratentorial ischemic or hemorrhagic lesion , ability to follow verbal commands , and walk 10 m with or without mobility aids . they were excluded from the study if they had unstable medical conditions , severe sensory impairment , visual field defect , and any other neurological or musculoskeletal disease affecting standing balance . the pelvic alignment in standing was assessed by palpation meter ( palm device ) , while the wba was tested using two standard weighing scales . the coin - toss method was used to determine the order of tests in each patient . four qualified physical therapists administered both the pelvic tilt and wba test measures . between two test measures , the palm device has been tested for its intra- and inter - rater reliability in measuring pelvic obliquity in people with stroke . to measure the pelvic alignment , each patient was instructed to stand straight with feet placed 30 cm apart . for measuring lateral pelvic tilt , the therapist stood behind the patient and placed the caliper tips at the highest part of iliac crests . the therapist stood by the side of the patient and placed the caliper tips at anterior superior iliac spine and posterior superior iliac spine to assess forward pelvic tilt . the actual body weight of patient was recorded using standard weighing scale before testing weight asymmetry . in clinical practice , standing on two standard weighing scales is the feasible and reliable mode of evaluating unequal limb loading on feet after stroke . two weighing machines were placed next to each other so that each patient stood on weighing scales with feet placed 30 cm wide apart . the formula of wba is = ( [ weight on most affected leg - weight on least affected leg]/total body weight ) 100 . pearson correlation coefficient ( r ) was used to find the relationship of lateral pelvic tilt and anterior pelvic tilt toward the most and least affected sides with the percentage of wba in chronic stroke . the  r  is interpreted as very low ( < 0.20 ) , low ( 0.200.39 ) , moderate ( 0.400.59 ) , high ( 0.600.79 ) , and very high ( 0.801.00 ) , respectively . the significance level was set at p < 0.05 and the p < 0.001 was considered highly statistically significant . the scattergram plotted in figures 1 - 3 shows the degree of pelvic tilt and its relation to wba in chronic stroke . correlation between lateral pelvic tilt ( degree ) and weight - bearing asymmetry ( % ) correlation between anterior pelvic tilt toward most affected side ( degree ) and weight - bearing asymmetry ( % ) correlation between anterior pelvic tilt toward least affected ( degree ) and weight - bearing asymmetry ( % ) pearson correlation coefficient ( r ) was used to find the relationship of lateral pelvic tilt and anterior pelvic tilt toward the most and least affected sides with the percentage of wba in chronic stroke . the  r  is interpreted as very low ( < 0.20 ) , low ( 0.200.39 ) , moderate ( 0.400.59 ) , high ( 0.600.79 ) , and very high ( 0.801.00 ) , respectively . the significance level was set at p < 0.05 and the p < 0.001 was considered highly statistically significant . the scattergram plotted in figures 1 - 3 shows the degree of pelvic tilt and its relation to wba in chronic stroke . correlation between lateral pelvic tilt ( degree ) and weight - bearing asymmetry ( % ) correlation between anterior pelvic tilt toward most affected side ( degree ) and weight - bearing asymmetry ( % ) correlation between anterior pelvic tilt toward least affected ( degree ) and weight - bearing asymmetry ( % ) one hundred and twelve patients with first - ever stroke were recruited in the study . the study included 70 males ( 63% ) and 42 ( 37% ) females with the mean age of 55 years and 14 months poststroke duration . this study included more number of patients with ischemic stroke ( 68 participants ) than hemorrhagic stroke lesion ( 44 ) . thirty - nine patients ( 35% ) had a left - sided stroke and 73 ( 65% ) had a right - sided stroke . the mean lower limb motor recovery stage was 3.7 ( 0.8 ) as per brunnstrom 's stroke recovery grading . seventy - two patients ( 64% ) were walking without any mobility aid , while 40 patients ( 36% ) were using either cane or tripod [ table 1 ] . on the measurement of pelvic alignment while in standing , it was tilted 2.47 ( 1.8 ) degree laterally toward the most affected side and 4.4 ( 1.8 ) degree anteriorly on the most and least affected sides . the lateral pelvic tilt was highly correlated to wba ( r = 0.631 ; p < 0.001 ) than anterior pelvic tilt ( r = 0.44 ; p < 0.001 ) [ table 2 and figures 1 - 3 ] . demographic characteristics of people with stroke correlation between pelvic tilt ( degree ) and weight - bearing asymmetry ( % ) in people after stroke ( n=112)^ the purpose of the study was to test the relationship between pelvic alignment and percentage of wba in community - dwelling chronic stroke survivors . the worse lateral pelvic tilt angle on the most affected side was highly correlated to wba ( r = 0.631 ) compared to anterior pelvic tilt ( r = 0.44 ) . we believe that the poor muscular control of trunk and hip could be the reason for altered pelvic alignment in standing . this was supported by the recent work in which the lateral tilt toward the most affected side and anterior pelvic tilt in standing were moderately correlated to trunk control , and these correlations were high in chronic stroke patients with better lower limb motor recovery . excessive lateral pelvic tilt on the most affected side could be one of the key factors for wba in stroke . while in standing , the normal side  side pelvic alignment is controlled by the activity of hip abductors along with trunk control . stated that the impaired recovery pattern of hip abductor and adductor in standing after stroke is majorly responsible for side to side balance stability . the muscles of the lower trunk and hip working onto pelvis in anterior - posterior direction seem to be vital for activation of hip abductor and trunk side flexor during side - to - side weight shifts . such muscular coordination is required for dynamic pelvic stability , thus allowing better weight - bearing symmetry after stroke . on measuring the center of pressure displacement during forward trunk bending and reaching in people after stroke , chern et al . observed less pressure distribution toward most affected side even the task demand was high . posturography analysis revealed that balance ability after stroke as measured by berg balance scale was strongly correlated to lateral weight shift ability than anterioposterior weight shifts . a recent cross - sectional study by pathak et al . found an excessive lateral pelvic tilt in sitting and was related to lateral sitting balance control recovery in stroke . it has always been a focus for physical therapists working with people after stroke to enhance weight transfer ability toward the most affected side . trunk exercise protocol emphasizing the weight - shift training in patients with chronic stroke also showed beneficial effects on functional balance ability . in the current study , we observed more anterior pelvic tilt on the most and least affected sides and was moderately correlated to wba . since trunk is bilaterally innervated and biomechanically connected to linea alba with its myofascial connections , any unilateral brain lesion typically affects the entire abdominal muscles , in turn , influences the position of both anterior superior iliac spines . nevertheless , the posterior myofascial connections of gluteus maximus extending to thoracolumbar fascia along with anterior myofascial sequences of the abdominal wall are also important for anterioposterior pelvic stability . following stroke , forward leaning posture with anteriorly tilted pelvis is common and this atypical postural alignment was correlated to trunk and balance dysfunction . this suggests that pelvic stability in forward - backward direction is well coordinated by trunk - pelvic and pelvis - hip dissociation . it is interesting to note that pelvis plays a role of the trunk in sitting whereas it is mainly a part of the lower extremity in standing . in sitting , the forward inclination of the trunk in sagittal direction was assisted by hip extensors , whereas the sideways movement of the body was not controlled by leg muscles , but only by trunk muscles . however , people with worse lower trunk control shall fix the pelvic backward and can translate the body weight forward by excessively flexing upper trunk . furthermore , the weight - bearing center of pressure values on feet as measured by force plates was less in people poststroke compared to age - matched healthy people suggesting that asymmetrical weight bearing is always an issue during many of the functional tasks . people poststroke seem to be relying on anterioposterior balance recovery than lateral balance recovery warranting stroke rehabilitation strategies toward improving lateral pelvic stability and symmetrical weight bearing . the amount of pelvic rotation , a major postural deviation observed in transverse plane poststroke , was not studied in this study due to its methodological limitations . the percentage of wba is majorly affected by lateral pelvic alignment than anterior - posterior alignment in community - dwelling chronic stroke survivors .
background and purpose : altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke . 
 the purpose of this study was to find the relationship between pelvic alignment and weight - bearing asymmetry ( wba ) in community - dwelling chronic stroke survivors.materials and methods : this cross - sectional study was conducted in tertiary care rehabilitation centers . in standing , the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation ( palm ) meter device . 
 the percentage of wba was measured with two standard weighing scales . 
 pearson correlation coefficient ( r ) was used to study the correlation between pelvic tilt and wba.results:of 112 study participants , the mean ( standard deviation ) age was 54.7 ( 11.7 ) years and the poststroke duration was 14 ( 11 ) months . 
 the lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 ( 1.8 ) and 4.4 ( 1.8 ) degree , respectively . 
 the percentage of wba was 23.2 ( 18.94 ) . 
 there was a high correlation of lateral pelvic tilt with wba ( r = 0.631 ; p < 0.001 ) than anterior pelvic tilt ( r = 0.44 ; p < 0.001).conclusion : excessive lateral pelvic tilt toward the most affected side in standing may influence the weight - bearing ability of the ipsilateral lower extremity in community - dwelling chronic stroke survivors .