Postural control of patients with hemiparesis: force plates measurements based on the clinical sensory organization test

Standing balance of hemiparetic patients is characterized by increased sway and an asymmetrical weight bearing distribution. The objectives of the study were to determine the feasibility of using a modified clinical sensory organization test with patients following a stroke and to evaluate the contribution of visual and somatosensory input to the standing balance of hemiparetic patients during the first two months following a stroke. Thirty patients with hemiparesis underwent functional and posturographic testing one and two months following their stroke. Testing was conducted in six stance conditions differing in somatosensory and visual input. Fifteen age-matched non-impaired subjects served as the control group. Sway Index (SI) representing the displacement of the subjects’ center of pressure during stance, was generally affected by time (p = 0.003), visual input (p = 0.0001), and somatosensory input (p = 0.0061), with the effect of vision significantly greater in the patient group as compared with the control group (p = 0.0006). Despite significant functional gains in the Barthel Index and functional ambulation (p = 0.01), percentage of body weight on the involved extremity (%BW) by stance condition did not change over time. Posturographic testing is useful for determining the sensory organization abilities of stroke patients with moderate impairment and indicates that these patients are dependent on visual input for postural control. The decrease in %BW borne on the affected extremity does not change over time or with the varying of sensory input.

[1]  F. O. Black,et al.  Adaptation to altered support and visual conditions during stance: patients with vestibular deficits , 1982, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[2]  B. Johansson,et al.  Sensory Stimulation Promotes Normalization of Postural Control After Stroke , 1994, Stroke.

[3]  K. M. Gill,et al.  Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. , 1984, Physical therapy.

[4]  M. Woollacott,et al.  Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance. , 1994, Journal of gerontology.

[5]  R. P. Fabio,et al.  Stance duration under sensory conflict conditions in patients with hemiplegia. , 1991, Archives of physical medicine and rehabilitation.

[6]  Y. Laufer,et al.  Standing Balance and Functional Recovery of Patients with Right and Left Hemiparesis in the Early Stages of Rehabilitation , 2003, Neurorehabilitation and neural repair.

[7]  H. Cohen,et al.  Changes in sensory organization test scores with age. , 1996, Age and ageing.

[8]  J. Bernhardt,et al.  Changes in balance and locomotion measures during rehabilitation following stroke. , 1998, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[9]  Peterka Rj,et al.  AGE-RELATED CHANGES IN HUMAN POSTURE CONTROL: SENSORY ORGANIZATION TESTS , 1990 .

[10]  Y. Laufer.  Effects of one-point and four-point canes on balance and weight distribution in patients with hemiparesis , 2002, Clinical rehabilitation.

[11]  D A Winter,et al.  Sampling duration effects on centre of pressure summary measures. , 2001, Gait & posture.

[12]  F. Horak,et al.  Assessing the Influence of Sensory Interaction on Balance , 1986 .

[13]  J. Browne,et al.  Review of the Different Methods for Assessing Standing Balance , 2001 .

[14]  J. Bamford,et al.  Classification and natural history of clinically identifiable subtypes of cerebral infarction , 1991, The Lancet.

[15]  F. Horak,et al.  Contributions of altered sensation and feedback responses to changes in coordination of postural control due to aging. , 2002, Gait & posture.

[16]  F O Black,et al.  Age-related changes in human posture control: sensory organization tests. , 1990, Journal of vestibular research : equilibrium & orientation.

[17]  Y. Laufer,et al.  The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions. , 2003, Physical therapy.

[18]  D. Wade,et al.  The Barthel ADL Index: a standard measure of physical disability? , 1988, International disability studies.

[19]  R P Di Fabio,et al.  Relationship of sensory organization to balance function in patients with hemiplegia. , 1990, Physical therapy.

[20]  F. Horak,et al.  Assessing the influence of sensory interaction of balance. Suggestion from the field. , 1986, Physical therapy.

[21]  F. Horak,et al.  Components of postural dyscontrol in the elderly: A review , 1989, Neurobiology of Aging.

[22]  F. Horak.  Clinical assessment of balance disorders , 1997 .

[23]  C. Sackley,et al.  Falls, sway, and symmetry of weight-bearing after stroke. , 1991, International disability studies.

[24]  L. K. Boulgarides,et al.  Use of clinical and impairment-based tests to predict falls by community-dwelling older adults. , 2003, Physical therapy.

[25]  R. Kohen-Raz.  Application of Tetra-Ataxiametric Posturography in Clinical and Developmental Diagnosis , 1991, Perceptual and motor skills.

[26]  K. Mu,et al.  Computerized platform posturography for children: test-retest reliability of the sensory test of the VSR System. , 2002, Physical & occupational therapy in pediatrics.

[27]  H. Menz,et al.  Visual contribution to postural stability in older adults , 2000 .

[28]  K. M. Gill,et al.  Clinical Gait Assessment in the Neurologically Impaired , 1984 .

[29]  F. Collen.  The measurement of standing balance after stroke , 1995 .

[30]  Julie Bernhardt,et al.  Balance and mobility outcomes for stroke patients: a comprehensive audit. , 1997, The Australian journal of physiotherapy.

[31]  F O Black,et al.  Age-related changes in human posture control: motor coordination tests. , 1990, Journal of vestibular research : equilibrium & orientation.

[32]  E. Vicaut,et al.  Reliance on visual information after stroke. Part I: Balance on dynamic posturography. , 2004, Archives of physical medicine and rehabilitation.

[33]  F. Horak,et al.  Postural perturbations: new insights for treatment of balance disorders. , 1997, Physical therapy.

[34]  F. Horak.  Motor Control Models Underlying Neurologic Rehabilitation of Posture in Children , 1992 .

[35]  L. Carey,et al.  Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. , 1993, Archives of physical medicine and rehabilitation.

[36]  J. Jensen,et al.  Postural sensitivity to visual flow in aging adults with and without balance problems. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[37]  M. Hulliger,et al.  Proprioceptive control of posture: a review of new concepts. , 1998, Gait & posture.

[38]  E. Vicaut,et al.  Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlled trial. , 2004, Archives of physical medicine and rehabilitation.

[39]  N T Shepard,et al.  An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders. , 1999, Journal of vestibular research : equilibrium & orientation.

[40]  Michael A. Riley,et al.  Recurrence analysis of human postural sway during the sensory organization test , 2003, Neuroscience Letters.

[41]  M. Woollacott,et al.  Changes in posture control across the life span--a systems approach. , 1990, Physical therapy.

[42]  M Yekutiel,et al.  A controlled trial of the retraining of the sensory function of the hand in stroke patients. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[43]  P. E. Sullivan,et al.  Balance and physical impairments after stroke. , 1999, Archives of physical medicine and rehabilitation.

[44]  R. Dickstein,et al.  Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights , 2000, Clinical rehabilitation.