Balance and physical impairments after stroke

doi:10.1016/S0003-9993(99)90020-5

Archives of Physical Medicine and Rehabilitation

Volume 80, Issue 10, October 1999, Pages 1227-1233

https://doi.org/10.1016/S0003-9993(99)90020-5 Get rights and content

Abstract

Objective: To investigate the relationship among laboratory and clinical balance measures and physical impairments.

Design: A descriptive correlational study.

Setting: Research laboratory.

Participants: Thirty subjects with stroke, recruited through convenience sampling.

Main Outcome Measures: Postural sway was calculated in terms of center of pressure (COP) parameters including spectral characteristics. Clinical balance was measured using the Balance Scale. The assessed physical impairments included stages of lower limb motor recovery, ankle proprioception, and passive dorsiflexion range of the involved limb.

Results: The Balance Scale was correlated with COP speed (r = −.57), COP root mean square speed (r −.50), and COP mean frequency (r = −.50) in the anterior-posterior direction only. Moderate to high correlations were found among most of the COP parameters except spectral characteristics. Significant differences in postural sway were found among different stance in eyes-open (p = .00 to .02) and eyes-closed conditions (p = .00 to .04). Subjects with impaired ankle proprioception had significantly increased postural sway and decreased Balance Scale scores when compared with the subjects with intact ankle proprioception.

Conclusions: Some of the clinical and laboratory balance assessments were related, indicating that some components of the tests are similar, but some measured different aspects of balance. Postural sway was related to visual condition, stance position, and proprioception.

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Only the pathway and the velocity assessed by dynamic posturography were significantly higher (p < 0.05) in the younger group of patients compared with the controls. The older group of patients had significantly elevated parameters measured by both static (p < 0.01) and dynamic posturography (p < 0.05).
we conclude, using a sensitive and reproducible method to assess both static and dynamic adjustments to maintain balance, that postural instability is significantly greater in post-stroke patients than control subjects. This difference is demonstrable up to 4 years after stroke, despite full recovery of the affected side.
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Balance and ambulation are the result of a multicomponent control process through the interaction of the sensory and motor information. Despite the clinical relevance of the somatosensory system, its role has not drawn much attention from clinical researchers in that motor impairment is considered a major cause of dysfunction. There is little research on how somatosensory impairment alone affects functional disability after stroke. The purpose of this study was to investigate the effects of isolated somatosensory deficit on the balance and ambulation ability in patients with stroke. P38 latency of the SSEP was used to evaluate the integrity of the dorsal column-medial lemniscus pathway and the SSEP reference value was derived from the formula considering individual height and age. According to the SSEP latency, subjects were classified into 'normal', 'abnormal', and 'no response' group. A total of 110 supratentorial stroke patients with at least grade 4 of the Medical Research Council scale of lower extremity on the affected side were enrolled. Berg balance scale (BBS) and functional ambulatory categories (FAC) showed significant differences among the groups (P < 0.05). In post-hoc analysis, the BBS and FAC was significantly different between the 'normal' and 'abnormal SSEP' group (P = 0.013 for BBS, P = 0.004 for FAC) and the 'normal' and 'no response SSEP' group (P = 0.015 for BBS, P = 0.006 for FAC). We found that isolated somatosensory impairment has a negative effect on the balance and ambulation ability in patients with supratentorial stroke after the acute phase.
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ArticleBalance and physical impairments after stroke☆

Abstract

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

Arch Phys Med Rehabil

Gait Posture

J Biomech

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

Arch Phys Med Rehabil

Clin Biomech

Clin Biomech

Physiotherapy

Gait Posture

Sensory, neuromuscular, and biomechanical contributions to human balance

Clinical and laboratory measures of postural balance in an elderly population

Arch Phys Med Rehabil

Force platform measures for evaluating postural control: reliability and validity

Arch Phys Med Rehabil

Normal postural stability and steadiness: quantitative assessment

J Bone Joint Surg Am

Article
Balance and physical impairments after stroke☆