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Leplaideur S, Allart E, Chochina L, Pérennou D, Rode G, Boyer FC, Paysant J, Yelnik A, Jamal K, Duché Q, Morcet JF, Laviolle B, Combès B, Bannier E, Bonan I. Neck muscle vibration and prism adaptation fail to improve balance disturbances after stroke: A multicentre randomised controlled study. Ann Phys Rehabil Med 2024; 67:101871. [PMID: 39173550 DOI: 10.1016/j.rehab.2024.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pilot studies suggest potential effects of neck muscle vibration (NMV) and prism adaptation (PA) on postural balance disturbances related to spatial cognition. OBJECTIVES To evaluate the effect of 10 sessions of NMV and/or PA on ML deviation. We used the mediolateral centre of pressure position (ML deviation) as a biomarker for spatial cognition perturbation, hypothesising that PA and NMV would improve ML deviation, with a potential synergistic impact when used together. METHODS We conducted a multicentre, single-blind, randomised controlled study. Participants within 9 months of a right-hemisphere supratentorial stroke and with less than 40% body weight supported on the paretic side in standing were randomised into 4 groups (PA, NMV, PA+NMV, or control). PRIMARY OUTCOME ML deviation at Day 14. SECONDARY OUTCOMES force platform data, balance abilities, autonomy, and ML deviation, measured just after the first session (Day 1), at Day 90, and Day 180. A generalised linear mixed model (GLMM) assessed intervention effects on these outcomes, adjusting for initial ML deviation and incorporating other relevant factors. RESULTS 89 participants were randomised and data from 80 participants, mean (SD) age 59.2 (10.2) years, mean time since stroke 94 (61) days were analysed. At Day 14, a weak time x group interaction (P = .001, omega-squared = 0.08) was found, with no significant between-group differences in ML deviation (P = .12) or in secondary outcomes (P = .08). Between-group differences were found on Day 1 (P = .03), Day 90 (P = .001) and Day 180 (P < .0001) regardless of age and stroke-related data. On Day 1, ML deviation improved in both the PA and NMV groups (P = .03 and P = .01). In contrast, ML deviation deteriorated in the NMV+PA group on Day 90 and Day 180 (P = .01 and P = .01). CONCLUSIONS The study found no evidence of any beneficial effects of repeated unimodal or combined sessions of NMV and/or PA on ML deviation after stroke. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01677091.
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Affiliation(s)
- Stephanie Leplaideur
- CHU Rennes, Hopital Pontchaillou, service MPR adulte, Rennes, France; Univ Rennes, Inria, CNRS, Inserm, Irisa UMR 6074, EMPENN-ERL, U1228, Rennes, France; Inserm, CIC 1414, Rennes, France; CRRF Kerpape, Ploemeur, France.
| | - Etienne Allart
- CHU de Lille, Service de Rééducation Neurologique Cérébrolésion, INSERM U1172 Lille Neuroscience et Cognition, Université de Lille, Lille, France
| | | | - Dominic Pérennou
- Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Dept of NeuroRehabilitation South Hospital, Cs 10217 - 38043 Grenoble cedex 9, France
| | - Gilles Rode
- Hospices civils de Lyon, Hopital Henry-Gabrielle, Service de MPR, Saint-Genis-Laval, France
| | - François Constant Boyer
- CHRU Reims, Unités de Médecine Physique et de Réadaptation, Hôpital Sébastopol, Université Reims Champagne-Ardenne (URCA), EA3797, Reims, France
| | - Jean Paysant
- Institut Régional de Réadaptation, Nancy, France
| | - Alain Yelnik
- APHP Lariboisière, Université Paris Diderot,service MPR, GH Saint Louis - Lariboisière - F. Widal, Paris, France
| | | | - Quentin Duché
- Univ Rennes, Inria, CNRS, Inserm, Irisa UMR 6074, EMPENN-ERL, U1228, Rennes, France
| | | | - Bruno Laviolle
- Inserm, CIC 1414, Rennes, France; Univ Rennes, CHU Rennes, Inserm, CIC 1414, Rennes, France
| | - Benoit Combès
- Univ Rennes, Inria, CNRS, Inserm, Irisa UMR 6074, EMPENN-ERL, U1228, Rennes, France
| | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, Irisa UMR 6074, EMPENN-ERL, U1228, Rennes, France; CHU Rennes, Department of Radiology, Rennes, France
| | - Isabelle Bonan
- CHU Rennes, Hopital Pontchaillou, service MPR adulte, Rennes, France; Univ Rennes, Inria, CNRS, Inserm, Irisa UMR 6074, EMPENN-ERL, U1228, Rennes, France; Inserm, CIC 1414, Rennes, France
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Galvão WR, Castro Silva LK, Viana RT, Oliveira PHA, Jucá RVBDM, Martins HR, Rabelo M, Fachin-Martins E, Lima LAO. Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study. Hong Kong J Occup Ther 2024; 37:21-30. [PMID: 38912104 PMCID: PMC11192430 DOI: 10.1177/15691861241241776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/10/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.
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Yamanaka E, Goto R, Kawakami M, Tateishi T, Kondo K, Nojima I. Intermuscular Coherence during Quiet Standing in Sub-Acute Patients after Stroke: An Exploratory Study. Brain Sci 2023; 13:1640. [PMID: 38137088 PMCID: PMC10742243 DOI: 10.3390/brainsci13121640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Asymmetrically impaired standing control is a prevalent disability among stroke patients; however, most of the neuromuscular characteristics are unclear. Therefore, the main purpose of this study was to investigate between-limb differences in intermuscular coherence during quiet standing. Consequently, 15 patients who had sub-acute stroke performed a quiet standing task without assistive devices, and electromyography was measured on the bilateral tibialis anterior (TA), soleus (SL), and medial gastrocnemius (MG). The intermuscular coherence of the unilateral synergistic (SL-MG) pair and unilateral antagonist (TA-SL and TA-MG) pairs in the delta (0-5 Hz) and beta (15-35 Hz) bands were calculated and compared between the paretic and non-paretic limbs. The unilateral synergistic SL-MG coherence in the beta band was significantly greater in the non-paretic limb than in the paretic limb (p = 0.017), while unilateral antagonist TA-MG coherence in the delta band was significantly greater in the paretic limb than in the non-paretic limb (p < 0.01). During quiet standing, stroke patients showed asymmetry in the cortical control of the plantar flexor muscles, and synchronous control between the antagonistic muscles was characteristic of the paretic limb. This study identified abnormal muscle activity patterns and asymmetrical cortical control underlying impaired standing balance in patients with sub-acute stroke using an intermuscular coherence analysis.
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Affiliation(s)
- Eiji Yamanaka
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan;
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1 Yatsu, Narashino 275-0026, Japan
| | - Ryosuke Goto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1 Yatsu, Narashino 275-0026, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1 Yatsu, Narashino 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takaki Tateishi
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1 Yatsu, Narashino 275-0026, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1 Yatsu, Narashino 275-0026, Japan
| | - Ippei Nojima
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan;
- Department of Rehabilitation Medicine, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-0001, Japan
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Oliveira FAF, Martins CP, de Oliveira LAS, Rodrigues EC, Ferreira AS, Lemos T. Poststroke consequences upon optimization properties of postural sway during upright stance: a cross-sectional study. Top Stroke Rehabil 2023; 30:663-671. [PMID: 36196904 DOI: 10.1080/10749357.2022.2130620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/24/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND The understanding of human postural control has advanced with the introduction of optimization process modeling. These models, however, only provide control parameters, rather than analytical descriptors of optimization processes. Here, we use a newly developed direct (pattern) search algorithm to investigate changes in postural optimization process in poststroke individuals. OBJECTIVE This cross-sectional study investigated the optimization properties of postural stability during upright standing in poststroke individuals. METHODS Twenty-nine poststroke and 15 healthy age-matched individuals underwent posturography with a force platform while standing for 60 s for acquisition of center-of-pressure data. Poststroke individuals were grouped depending on their weight-bearing (WB) pattern and their balance capability assessed through Berg Balance Scale (BBS). The optimization properties of postural stability were computed assuming the minimization of postural sway as cost function. RESULTS The asymmetric WB poststroke group showed larger convergence rate toward the local minimum of postural sway than the symmetric WB group. Additionally, the low-balance capability group exhibited smaller values for averaged local minima and global minimum of postural sway coordinates compared with high-balance capability group. Significant correlations were found for BBS and the local minima and global minimum (Pearson's r ranged 0.378-0.424, P < 0.05). CONCLUSIONS In summary, the optimization properties describing postural dynamic stability, steadiness, and global reference are altered in poststroke individuals with asymmetric WB pattern and low-balance capability.
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Affiliation(s)
- Flávia A F Oliveira
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - Camilla P Martins
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - Laura A S de Oliveira
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro - IFRJ, Rio de Janeiro, Brazil
| | - Erika C Rodrigues
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
- Instituto D'Or de Ensino e Pesquisa - IDOR, Rio de Janeiro, Brazil
| | - Arthur S Ferreira
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - Thiago Lemos
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
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Arabzadeh S, Kamali F, Bervis S, Razeghi M. The hip joint mobilization with movement technique improves muscle activity, postural stability, functional and dynamic balance in hemiplegia secondary to chronic stroke: a blinded randomized controlled trial. BMC Neurol 2023; 23:262. [PMID: 37434123 DOI: 10.1186/s12883-023-03315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity in balance maintenance, hip joint mobilization with movement technique can be applied to enhance normal joint arthrokinematics. Therefore, the present study aimed to investigate the effectiveness of hip joint mobilization with movement technique on stroke patients' muscle activity and balance. METHODS Twenty patients aged between 35 and 65 years old with chronic stroke were randomly assigned either to an experimental group (n = 10) or to a control group (n = 10). Both groups participated in a 30-minute conventional physiotherapy session 3 times per week for 4 weeks. The experimental group received an additional 30-minute's session of hip joint mobilization with movement technique on the affected limb. The muscle activity, berg balance scale, time up and go, and postural stability were measured at baseline, 1-day and 2-week follow-up by a blinded assessor. RESULTS The experimental group showed a significant improvement in berg balance scale, time up and go, and postural stability (p ≤ 0.05). The rectus femoris, tibialis anterior, biceps femoris, and medial gastrocnemius muscles' activations of the affected limb during static balance test markedly changed along with the biceps femoris, erector spine, rectus femoris, and tibialis anterior muscles during dynamic balance test after hip joint mobilization with movement technique. The mean onset time of rectus abdominus, erector Spine, rectus femoris, and tibialis anterior muscles activity significantly decreased in the affected limb after hip joint mobilization with movement technique compared to the control group (p ≤ 0.05). CONCLUSIONS The results of the present study suggest that a combination of hip joint mobilization with movement technique and conventional physiotherapy could improve muscle activity and balance among chronic stroke patients. TRIAL REGISTRATION NUMBER The study was registered in the Iranian Registry of Clinical Trials (No; IRCT20200613047759N1). Registration date: 2/08/2020.
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Affiliation(s)
- Soudeh Arabzadeh
- Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soha Bervis
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Pérennou D, Chauvin A, Piscicelli C, Hugues A, Dai S. Determining an optimal posturography dataset to identify standing behaviors in the post-stroke subacute phase. Cross-sectional study. Ann Phys Rehabil Med 2023; 66:101707. [PMID: 36182062 DOI: 10.1016/j.rehab.2022.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND A key issue for posturography is the expression of robust results, in a simplified way. Most studies of individuals post-stroke concern the chronic phase, with small sample sizes. OBJECTIVES By reducing the number of posturographic indices, we aimed to determine an optimal dataset and understand typical postural behaviors in the subacute post-stroke phase. METHODS In this cross-sectional study ancillary to the DOBRAS cohort, individuals were assessed as soon they could complete a full posturography session (with and without vision) after a first hemispheric stroke. Body-weight distribution on the mediolateral (ML) axis, position of the center of pressure on the antero-posterior (AP) axis, and postural sway on both axes were computed. Balance ability in daily life was quantified with the Postural Assessment Scale for Stroke. Data were analyzed by principal component and hierarchical clustering analyses as well as multiple linear regression. RESULTS We enrolled 95 individuals (median age: 67.0 years [Q1; Q3 56.0; 72.0]; 68% males). Vision suppression had a marginal effect, only increasing postural sway. Regardless of the visual condition, posturographic behavior was captured by a set of 3 indices that explained almost all the information. One postural sway index (ML or AP) gave more information (48%) than both position indices (ML 26% and AP 15%). These 3 indices identified 3 standing behaviors: 1) stable and symmetric, 2) asymmetric, unstable, and positioned backward, and 3) very unstable and positioned forward. Balance ability in daily life was explained (49% of the information, 95%CI [35; 63]) by weight-bearing asymmetry and postural sway on the ML axis, which played an independent role (both p<10-5), with similar impact. CONCLUSIONS Three typical behaviors allow standing after stroke: described by only 3 posturographic indices. Weight-bearing asymmetry is not the primary parameter and should not be considered in isolation as an outcome. To increase the feasibility of posturography in the early subacute phase and to simplify evaluation sessions, trials could be limited to eyes open. REGISTRATION NCT03203109.
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Affiliation(s)
- Dominic Pérennou
- Univ. Grenoble-Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, CS 10217, 38043 Grenoble cedex 9, France.
| | - Adèle Chauvin
- Univ. Grenoble-Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - Céline Piscicelli
- Univ. Grenoble-Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - Aurélien Hugues
- Univ. Grenoble-Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - Shenhao Dai
- Univ. Grenoble-Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, CS 10217, 38043 Grenoble cedex 9, France
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Jonsdottir J, Mestanza Mattos FG, Torchio A, Corrini C, Cattaneo D. Fallers after stroke: a retrospective study to investigate the combination of postural sway measures and clinical information in faller's identification. Front Neurol 2023; 14:1157453. [PMID: 37181569 PMCID: PMC10174247 DOI: 10.3389/fneur.2023.1157453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023] Open
Abstract
Background Falls can have devastating effects on quality of life. No clear relationships have been identified between clinical and stabilometric postural measures and falling in persons after stroke. Objective This cross-sectional study investigates the value of including stabilometric measures of sway with clinical measures of balance in models for identification of faller chronic stroke survivors, and the relations between variables. Methods Clinical and stabilometric data were collected from a convenience sample of 49 persons with stroke in hospital care. They were categorized as fallers (N = 21) or non-fallers (N = 28) based on the occurrence of falls in the previous 6 months. Logistic regression (model 1) was performed with clinical measures, including the Berg Balance scale (BBS), Barthel Index (BI), and Dynamic Gait Index (DGI). A second model (model 2) was run with stabilometric measures, including mediolateral (SwayML) and anterior-posterior sway (SwayAP), velocity of antero-posterior (VelAP) and medio-lateral sway (VelML), and absolute position of center of pressure (CopX abs). A third stepwise regression model was run including all variables, resulting in a model with SwayML, BBS, and BI (model 3). Finally, correlations between independent variables were analyzed. Results The area under the curve (AUC) for model 1 was 0.68 (95%CI: 0.53-0.83, sensitivity = 95%, specificity = 39%) with prediction accuracy of 63.3%. Model 2 resulted in an AUC of 0.68 (95%CI: 0.53-0.84, sensitivity = 76%, specificity = 57%) with prediction accuracy of 65.3%. The AUC of stepwise model 3 was 0.74 (95%CI: 0.60-0.88, sensitivity = 57%, specificity = 81%) with prediction accuracy of 67.4%. Finally, statistically significant correlations were found between clinical variables (p < 0.05), only velocity parameters were correlated with balance performance (p < 0.05). Conclusion A model combining BBS, BI, and SwayML was best at identifying faller status in persons in the chronic phase post stroke. When balance performance is poor, a high SwayML may be part of a strategy protecting from falls.
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Affiliation(s)
- Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- *Correspondence: Johanna Jonsdottir,
| | | | | | | | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Jamal K, Cordillet S, Leplaideur S, Rauscent H, Cogné M, Bonan I. Reliability and minimal detectable change of body-weight distribution and body sway between right and left brain-damaged patients at a chronic stage. Disabil Rehabil 2023; 45:260-265. [PMID: 35107054 DOI: 10.1080/09638288.2022.2030418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the reliability and minimal detectable change (MDC) of weight-bearing asymmetry (WBA) and body sway (BS) during "eyes open" (EO) and "eyes closed" (EC) conditions for those with right brain damage (RBD) and left brain damage (LBD) at a chronic stage. METHODS Sixteen RBD and 16 LBD patients participated in two sessions within 15 days, composed of two trials of 30 s using a double force platform. Intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), and MDC were calculated for WBA and BS (area and velocity of sway). RESULTS Reliability of WBA was excellent (>0.75) except for EC for LBD patients (low SEM was found). The condition of EC was similar to or less reliable than that of EO. The MDC of WBA was 5.4 and 7.3% for LBD and RBD patients, respectively. Velocity of sway should be favored over the area of sway due to better reliability, with an MDC of 9 and 13 mm/s for RBD and LBD patients, respectively. CONCLUSIONS Parameters related to WBA and BS were highly reliable, without a difference between RBD and LBD patients, but less so in the condition of EC, and could be used for clinical rehabilitation and/or research.Implications for rehabilitationWeight-bearing asymmetry (WBA) and body sway (BS) are highly reliable posturography parameters.Reliability of WBA/BS is similar among right brain damaged (RBD) and left brain damaged (LBD) patients.A change of 5-7% can be interpreted as significant for WBA for chronic stroke.The minimal detectable change in measures is slightly higher for RBD patients.
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Affiliation(s)
- Karim Jamal
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
- M2S Laboratory - EA 1274, University of Rennes 2, Rennes, France
| | - Sébastien Cordillet
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
| | - Stéphanie Leplaideur
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Hélène Rauscent
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
| | - Mélanie Cogné
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Isabelle Bonan
- Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
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Ostrowska PM, Studnicki R, Rykaczewski M, Spychała D, Hansdorfer-Korzon R. Evaluation of the Effect of SPIDER System Therapy on Weight Shifting Symmetry in Chronic Stroke Patients-A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16214. [PMID: 36498288 PMCID: PMC9735549 DOI: 10.3390/ijerph192316214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: The Strengthening Program for Intensive Developmental Exercises and Activities for Reaching Health Capability (SPIDER) system is dedicated to patients with motor deficits resulting from damage to the peripheral or central nervous system (including post-stroke patients). It enables the conduct of forced-weight-bearing therapy to the lower limb affected by the paresis. In this study, the TYMO® measuring platform was used to quantify the impact of therapy using the SPIDER system and therapy that did not use this system. The TYMO® device is a portable posturography platform that monitors the tilting of the body's center of mass and reports the results of the rehabilitation process. (2) Objective: To evaluate the effect of therapy based on neurophysiological methods (proprioceptive neuromuscular facilitation (PNF), neurodevelopmental treatment according to the Bobath concept (NDT-Bobath)) and the SPIDER system on body weight transfer shifting, in post-stroke patients in the chronic phase, compared to therapy based on neurophysiological methods (PNF, NDT-Bobath), without the use of the SPIDER system. (3) Methods: This is a randomized controlled trial in which patients (n = 120; adults, post-ischemic stroke-first stroke episode, in chronic phase-up to 5 years after the stroke incident) were assigned to one of two groups: study, n = 60 (with therapy using PNF, NDT-Bobath methods and the SPIDER system); and control, n = 60 (with therapy using PNF and NDT-Bobath methods, without the SPIDER system). In patients in both groups, before and after the training (2 weeks of therapy), body weight distribution was measured on the TYMO® platform. (4) Results and Conclusions: The results of the statistical analysis demonstrated a greater reduction in the tilt of the body's center of mass in therapy using the SPIDER system, compared to therapy in which the system was not used.
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Affiliation(s)
| | - Rafał Studnicki
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland
| | - Marcin Rykaczewski
- Second Department of Radiology, Medical University of Gdańsk, 17 M. Smoluchowskiego St., 80-214 Gdańsk, Poland
| | - Dawid Spychała
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland
| | - Rita Hansdorfer-Korzon
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland
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Cho S, Lee KD, Park HS. A Mobile Cable-Tensioning Platform to Improve Crouch Gait in Children with Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1092-1102. [PMID: 35442888 DOI: 10.1109/tnsre.2022.3167472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Gait impairment represented by crouch gait is the main cause of decreases in the quality of lives of children with cerebral palsy. Various robotic rehabilitation interventions have been used to improve gait abnormalities in the sagittal plane of children with cerebral palsy, such as excessive flexion in the hip and knee joints, yet in few studies have postural improvements in the coronal plane been observed. The aim of this study was to design and validate a gait rehabilitation system using a new cable-driven mechanism applying assist in the coronal plane. We developed a mobile cable-tensioning platform that can control the magnitude and direction of the tension vector applied at the knee joints during treadmill walking, while minimizing the inertia of the worn part of the device for less obstructing the natural movement of the lower limbs. To validate the effectiveness of the proposed system, three different treadmill walking conditions were performed by four children with cerebral palsy. The experimental results showed that the system reduced hip adduction angle by an average of 4.57 ± 1.79° compared to unassisted walking. Importantly, we also observed improvements of hip joint kinematics in the sagittal plane, indicating that crouch gait can be improved by postural correction in the coronal plane. The device also improved anterior and lateral pelvic tilts during treadmill walking. The proposed cable-tensioning platform can be used as a rehabilitation system for crouch gait, and more specifically, for correcting gait posture with minimal disturbance to the voluntary movement.
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Wiskerke E, van Dijk M, Thuwis R, Vandekerckhove C, Myny C, Kool J, Dejaeger E, Beyens H, Verheyden G. Maximum weight-shifts in sitting in non-ambulatory people with stroke are related to trunk control and balance: a cross-sectional study. Gait Posture 2021; 83:121-126. [PMID: 33129172 DOI: 10.1016/j.gaitpost.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impaired sitting balance is common in persons with stroke, affecting postural control in different directions. However, studies seldomly investigate sitting balance in severely affected non-ambulatory persons with stroke and precise assessment including the diagonal directions are scarce. RESEARCH QUESTION Are measurements of maximal voluntary weight-shifts decreased in severely affected persons with stroke in comparison to healthy controls, and is there a relationship with clinical measurements of trunk control, sitting and standing balance? METHODS 14 Persons with stroke were recruited in the rehabilitation phase along with 32 healthy controls. A clinical pressure platform (RM Ingénierie, France) evaluated the weight-distribution during static sitting and measurements of maximal voluntary weight-shifts, by centre of pressure displacements in six directions. Clinical measurements included Trunk Control Test, Trunk Impairment Scale and Berg Balance Scale. RESULTS The persons with stroke had a mean (SD) age of 69 (17) years, including 5 females and 9 males and were on average 57 (40) days post stroke. No patient was able to walk without manual support and median (IQR) Berg Balance Scale score was 17 (6-33) out of 56 points. Measurements showed that the centre of pressure distance was significantly smaller in all directions in persons with stroke compared to healthy controls (p < 0.05). The clinical measurements demonstrated moderate to very high correlations with centre of pressure distance in the diagonal forward, diagonal backward and lateral directions (r = 0.54 - 0.89). SIGNIFICANCE This study reveals that measurements of maximal voluntary weight-shifts are feasible and show clinically relevant deficits in severely affected non-ambulatory persons with stroke. Especially the lateral and diagonal directions can be of interest to investigate further as they are most strongly correlated with clinical measurements of balance. Reaching exercises in these directions could be considered a core element of rehabilitation for this group of patients.
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Affiliation(s)
- Evelyne Wiskerke
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; Rehazentrum Valens - Kliniken Valens, Valens, Switzerland, Taminaplatz 1, 7317 Valens, Switzerland.
| | - Margaretha van Dijk
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Rhea Thuwis
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Chesny Vandekerckhove
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Charlotte Myny
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
| | - Jan Kool
- Rehazentrum Valens - Kliniken Valens, Valens, Switzerland, Taminaplatz 1, 7317 Valens, Switzerland.
| | - Eddy Dejaeger
- UZ Leuven - University Hospitals Leuven, Department of Geriatrics, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Hilde Beyens
- UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium.
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Martins CP, Xarles TM, Lemos T, Oliveira LASD. Avaliação da distribuição do peso corporal em hemiparéticos: medidas posturográficas versus o instrumento Avaliação da Simetria e Transferência de Peso. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19013727022020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A assimetria na distribuição do peso corporal (DPC) é um achado comum após um acidente vascular cerebral. Embora a posturografia seja considerada o padrão-ouro para a detecção da assimetria da DPC, exige equipamentos e conhecimentos específicos, limitando seu uso na prática clínica. Por outro lado, a Escala de Avaliação da Simetria e Transferência de Peso (ASTP) é um método simples para identificar a assimetria na DPC. Entretanto, não foi testado se seus resultados estão relacionados às medidas posturográficas. Assim, o objetivo desse estudo foi avaliar a validade concorrente por meio da identificação do grau de associação entre a ASTP e as medidas posturográficas da DPC em indivíduos com hemiparesia. Sessenta indivíduos, com hemiparesia [mediana (min-max)] 58 (33-86) anos e 24 (6-29) meses desde o primeiro AVC, foram avaliados. zA DPC foi avaliada por meio da ASTP e da posturografia (percentual da DPC sobre o membro não parético). A mediana do escore ASTP foi 23 (14-27), “capacidade parcialmente boa de simetria e transferência de peso”. A posturografia revelou 59% de apoio do peso corporal (50-97) sobre o lado não parético. Além disso, identificou uma proporção maior de indivíduos assimétricos do que a ASTP (29 vs. 8; p=0,003). Não houve correlação significativa entre ASTP e %DPC (rho=0,001, p=0,992). Concluiu-se que a ASTP não está relacionada à assimetria na DPC estimada pela posturografia, sugerindo a necessidade de uma reavaliação de sua utilidade clínica.
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Vieira TM, Lemos T, Oliveira LAS, Horsczaruk CHR, Freitas GR, Tovar-Moll F, Rodrigues EC. Postural Muscle Unit Plasticity in Stroke Survivors: Altered Distribution of Gastrocnemius' Action Potentials. Front Neurol 2019; 10:686. [PMID: 31297085 PMCID: PMC6607468 DOI: 10.3389/fneur.2019.00686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Neuromuscular adaptations are well-reported in stroke survivors. The death of motor neurons and the reinnervation of residual muscle fibers by surviving motor neurons, for example, seem to explain the increased density of muscle units after stroke. It is, however, unknown whether reinnervation takes place locally or extensively within the muscle. Here we combine intramuscular and surface electromyograms (EMGs) to address this issue for medial gastrocnemius (MG); a key postural muscle. While seven stroke survivors stood upright, two intramuscular and 15 surface EMGs were recorded from the paretic and non-paretic gastrocnemius. Surface EMGs were triggered with the firing instants of motor units identified through the decomposition of both intramuscular and surface EMGs. The standard deviation of Gaussian curves fitting the root mean square amplitude distribution of surface potentials was considered to assess differences in the spatial distribution of motor unit action potentials and, thus, in the distribution of muscle units between limbs. The median number of motor units identified per subject in the paretic and non-paretic sides was, respectively, 2 (range: 1–3) and 3 (1–4). Action potentials in the paretic gastrocnemius were represented at a 33% wider skin region when compared to the non-paretic muscle (Mann-Whitney; P = 0.014). Side differences in the representation of motor unit were not associated with differences in subcutaneous thickness (skipped-Spearman r = −0.53; confidence interval for r: −1.00 to 0.63). Current results suggest stroke may lead to the enlargement of the gastrocnemius muscle units recruited during standing. The enlargement of muscle units, as assessed from the skin surface, may constitute a new marker of neuromuscular plasticity following stroke.
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Affiliation(s)
- Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare (LISiN), Dipartimento di Elettronica e Telecomunicazioni, and PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - Thiago Lemos
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - Laura A S Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.,Graduação em Fisioterapia, Instituto Federal de Educação, Ciência e Tecnologia - IFRJ, Rio de Janeiro, Brazil
| | - Carlos H R Horsczaruk
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - Gabriel R Freitas
- Unidade de Conectividade Cerebral, Instituto D'Or de Pesquisa e Ensino - IDOR, Rio de Janeiro, Brazil
| | - Fernanda Tovar-Moll
- Unidade de Conectividade Cerebral, Instituto D'Or de Pesquisa e Ensino - IDOR, Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Ciências Mofológicas, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil
| | - Erika C Rodrigues
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.,Unidade de Conectividade Cerebral, Instituto D'Or de Pesquisa e Ensino - IDOR, Rio de Janeiro, Brazil
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Goffredo M, Guanziroli E, Pournajaf S, Gaffuri M, Gasperini G, Filoni S, Baratta S, Damiani C, Franceschini M, Molteni F. Overground wearable powered exoskeleton for gait training in subacute stroke subjects: clinical and gait assessments. Eur J Phys Rehabil Med 2019; 55:710-721. [PMID: 30723189 DOI: 10.23736/s1973-9087.19.05574-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Wearable powered exoskeletons provide intensive overground gait training with patient's active participation: these features promote a successful active motor relearning of ambulation in stroke survivors. AIM The aim of this study was to investigate the feasibility and the clinical effects of an overground exoskeleton-assisted gait training (OEAGT) in subacute stroke patients. DESIGN Prospective, pilot pre-post, open label, non-randomized experimental study. SETTING Four Italian neurological rehabilitation centers. POPULATION Forty-eight subacute stroke patients were enrolled. Two patients dropped out because of medical problems. Data analysis was conducted on 46 subjects (56.84±14.29 years; 27 male; 29 ischemic; 24 left hemiparesis). METHODS Patients underwent 15±2 sessions (60 min/session, 3-5 times/week) of OEAGT. Clinical and gait assessments were performed at the beginning (T1) and at the end (T2) of the training period: modified Barthel Index (BI), modified Ashworth Scale at Hip (MAS-H), Knee (MAS-K), and Ankle (MAS-A) level, Motricity Index (MI), Trunk Control Test (TCT), Functional Ambulation Classification (FAC), Walking Handicap Scale (WHS), 10-Meter Walking Test (10MWT), 6-Minute Walking Test (6mWT), Timed Up-and-Go test (TUG). The Technology Acceptance Model (TAM) questionnaire evaluated the acceptance of OEAGT by patients. Data stratification was performed using the time post the acute event and the onset of rehabilitation treatment, and the MI at T1. Wilcoxon's test (P<0.05) was used. RESULTS All clinical scales significantly improved at T2; no statistically significant changes were reported for MAS-H, MAS-K, MAS-A. The 69.57% patients were able to walk at T1; 17.39% were not able to walk at T1 but regained ambulation at T2; and 13.04% were not able to walk at either T1 or T2. The ambulant patients showed a statistical improvement in speed measured during the 10MWT and in the distance covered over a time of 6 minutes (6mWT). The results from the TAM questionnaire showed that all subjects perceived the OEAGT positively. The data stratification analysis suggests that the OEAGT does not have any restriction of use. CONCLUSIONS The OEAGT improved the clinical and gait outcomes in subacute patients. Randomized studies on larger samples are needed to confirm these data and to assess the efficacy of OEAGT. CLINICAL REHABILITATION IMPACT Introduce innovative rehabilitation strategies based on customized OEAGT.
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Affiliation(s)
- Michela Goffredo
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy -
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Sanaz Pournajaf
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marina Gaffuri
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Serena Filoni
- Padre Pio Non-profit Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Silvano Baratta
- Department of Intensive Neuromotor Rehabilitation, USL Umbria 2, Trevi, Perugia, Italy
| | - Carlo Damiani
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Franceschini
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University, Rome, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
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Rougier PR, Fleury PH, Tollenaere B. Attentional cost in additional visual feedback protocols in healthy young subjects. Exp Brain Res 2018; 237:547-555. [PMID: 30483829 DOI: 10.1007/s00221-018-5433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Additional visual feedback (VFB) is a technique allowing improved postural stability in young healthy individuals despite an increased muscular activity, the two trends being assessed through center-of-gravity (CGv) and differences between CGv and center-of-pressure (CP) movements (CP-CGv), respectively. These two opposing effects are likely explained by the respective contribution of automatic and voluntary controls and in turn the neural circuits involved. To specify these specific contributions, a dual-task protocol was set up, consisting in adding to VFB a navigation task performed at the maximum cognitive capacities of the subjects who were evaluated beforehand. Overall, the protocol comprises six conditions: three visual tasks (eyes open without VFB, VFBBW based on body-weight distribution, VFBCP based on CP displacements) associated with or without a cognitive task. Variances of CP-CGv and CGv movements, along the mediolateral (ML) and anteroposterior (AP) axes, and parameters from fractional Brownian motion modeling (transition point coordinates and scaling regimes to assess the level of deterministic or stochastic activity) were used to assess the postural behaviors. The results show that during VFBCP, the dual tasks protocol infers a decreased contribution of deterministic activity in CP-CGv movements, inducing decreased variances, and alters the correction of the CGv over the longest Δt but nonetheless without changing CGv variances. Disturbing the subject's attention during the VFBBW condition induces decreased CP-CGv and CGv movements along the ML and AP axes, respectively. These data demonstrate the high level of attention induced by VFB protocols. If the tonic postural activity, expressed through CP-CGv movements, decreases whatever VFB condition along both the ML and AP axes, the effects on CGv movement appear to be mostly related to the additional information (BW or CP) provided. Overall, if too much voluntary control in upright stance maintenance is detrimental for the magnitudes of the CP-CGv movements, it appears beneficial for those of the CGv movements. By emphasizing the role of automatic and voluntary controls in VFB protocols, these insights document the neural circuits involved in such protocols and specify their conditions of use.
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Affiliation(s)
- Patrice R Rougier
- Laboratoire Interdisciplinaire de Biologie de la Motricité, EA 7424, Université de Savoie-Mont-Blanc, Domaine Scientifique de Savoie-Technolac, 73376, Le Bourget du Lac cedex, France.
| | - Paul-Henri Fleury
- Laboratoire Interdisciplinaire de Biologie de la Motricité, EA 7424, Université de Savoie-Mont-Blanc, Domaine Scientifique de Savoie-Technolac, 73376, Le Bourget du Lac cedex, France
| | - Baptiste Tollenaere
- Laboratoire Interdisciplinaire de Biologie de la Motricité, EA 7424, Université de Savoie-Mont-Blanc, Domaine Scientifique de Savoie-Technolac, 73376, Le Bourget du Lac cedex, France
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Dos Anjos FV, Gazzoni M, Vieira TM. Does the activity of ankle plantar flexors differ between limbs while healthy, young subjects stand at ease? J Biomech 2018; 81:140-144. [PMID: 30301550 DOI: 10.1016/j.jbiomech.2018.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
Inferences on the active contribution of plantar flexors to the stabilisation of human standing posture have been drawn from surface electromyograms (EMGs). Surface EMGs were however often detected unilaterally, presuming the myoelectric activity from muscles in a single leg reflects the pattern of muscle activation in both legs. In this study we question whether surface EMGs detected from plantar flexor muscles in both legs provide equal estimates of the duration of activity. Arrays of surface electrodes were used to collect EMGs from gastrocnemius and soleus muscles while twelve, young male participants stood at ease for 60 s. Muscles in each leg were deemed active whenever the Root Mean Square amplitude of EMGs (40 ms epochs) detected by any channel in the arrays exceeded the noise level, defined from EMGs detected during rest. The Chi-Square statistics revealed significant differences in the relative number of active periods for both muscles in 10 out of 12 participants tested, ranging from 2% to 65% (χ2 > 17.90; P < 0.01). Pearson correlation analysis indicated side differences in the duration of gastrocnemius though not soleus activity were associated with the centre of pressure mean, lateral position (R = 0.60; P = 0.035). These results suggest therefore that surface EMGs may provide different estimates of the timing of plantar flexors' activity if collected unilaterally during standing and that asymmetric activation may be not necessarily associated with weight distribution between limbs. Depending on the body side from which EMGs are collected, the active contribution of plantar flexors to standing stabilization may be either under- or over-valued.
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Affiliation(s)
- Fabio V Dos Anjos
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy; Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
| | - Marco Gazzoni
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy; Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Taian M Vieira
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy; Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
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Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
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18
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Martínez-Lemos RI, Ayán-Pérez C, Bouzas-Rico S. Test-retest reliability of the Wii Balance Board for assessing standing balance in young people with intellectual disability. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2017; 65:231-238. [PMID: 34141343 PMCID: PMC8115488 DOI: 10.1080/20473869.2017.1403065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives: The main objective was to identify the test-retest reliability of the Wii Balance Board (WBB) for assessing standing balance when administered to a population of people with intellectual disability (ID). A secondary objective was to provide information regarding the reliability of the WBB, taking into account the severity of cognitive impairment. Methods: The WBB was administered two times to a group of 50 people (mean age: 20.44 ± 5.73 years) with mild (n=32), moderate (n=6), or severe ID (n=12) within a 15-day period. The relative reliability of the WBB for the 'standing balance with open eyes' test was analyzed by means of intraclass correlation coefficients (ICCs). The standard error measurement and the minimum detectable change were used to identify absolute reliability. Results: For the whole sample, the WBB showed a fair (ICC=0.71), poor (ICC=0.66), and excellent (ICC=0.99) relative reliability for assessing weight-bearing asymmetry, center of pressure, path length, and sway area, respectively. In people with moderate/severe ID, statistically significant differences between the WBB test and retest scores were found. The absolute reliability of the WBB was considered poor. Conclusion: The WBB showed accurate adequate test-retest reliability for assessing standing balance in young people with ID. When using this device with people with moderate/severe ID, it is advisable to perform several testing trials, in order to avoid a possible learning effect. Standard error of measurement and minimal detectable change were high, indicating that this device might not be sensitive enough to properly identify static balance changes in this population.
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Affiliation(s)
| | - Cárlos Ayán-Pérez
- Faculty of Education and Sport Sciences, Campus A Xunqueira, Pontevedra, Spain
| | - Sara Bouzas-Rico
- Faculty of Education and Sport Sciences, Campus A Xunqueira, Pontevedra, Spain
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van Dijk MM, Meyer S, Sandstad S, Wiskerke E, Thuwis R, Vandekerckhove C, Myny C, Ghosh N, Beyens H, Dejaeger E, Verheyden G. A cross-sectional study comparing lateral and diagonal maximum weight shift in people with stroke and healthy controls and the correlation with balance, gait and fear of falling. PLoS One 2017; 12:e0183020. [PMID: 28809939 PMCID: PMC5557488 DOI: 10.1371/journal.pone.0183020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/28/2017] [Indexed: 11/20/2022] Open
Abstract
Impaired balance is common post stroke and can be assessed by means of force-platforms measuring center of pressure (COP) displacements during static standing, or more dynamically during lateral maximum weight shift (MWS). However, activities of daily life also include diagonal MWS and since force platforms are nowadays commercially available, investigating lateral and diagonal MWS in a clinical setting might be feasible and clinically relevant. We investigated lateral and diagonal MWS while standing in patients with stroke (PwS) and healthy controls (HC), evaluated MWS towards the affected and the non-affected side for PwS and correlated MWS with measures of balance, gait and fear of falling. In a cross-sectional observational study including 36 ambulatory sub-acute inpatients and 32 age-matched HC, a force platform (BioRescue, RM Ingénierie, France) was used to measure lateral and diagonal MWS in standing. Clinical outcome measures collected were Berg Balance Scale and Community Balance and Mobility Scale (CBMS) for balance, 10-meter walk test (10MWT) for gait speed and Falls Efficacy Scale–international version for fear of falling. MWS for PwS towards the affected side was significantly smaller compared to HC (lateral: p = 0.029; diagonal-forward: p = 0.000). MWS for PwS was also significantly reduced towards the affected side in the diagonal-forward direction (p = 0.019) compared to the non-affected side of PwS. Strong correlations were found for MWS for PwS in the diagonal-forward direction towards the affected side, and clinical measures of balance (CBMS: r = 0.66) and gait speed (10MWT: r = 0.66). Our study showed that ambulatory sub-acute PwS, in comparison to HC, have decreased ability to shift their body weight diagonally forward in standing towards their affected side. This reduced ability is strongly related to clinical measures of balance and gait speed. Our results suggest that MWS in a diagonal-forward direction should receive attention in rehabilitation of ambulatory sub-acute PwS in an inpatient setting.
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Affiliation(s)
- Margaretha M. van Dijk
- UZ Leuven — University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Pellenberg, Belgium
- * E-mail:
| | - Sarah Meyer
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Solveig Sandstad
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Evelyne Wiskerke
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Rhea Thuwis
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Chesny Vandekerckhove
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Charlotte Myny
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Nitesh Ghosh
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Hilde Beyens
- UZ Leuven — University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Pellenberg, Belgium
| | - Eddy Dejaeger
- UZ Leuven — University Hospitals Leuven, Department of Geriatrics, Pellenberg, Belgium
| | - Geert Verheyden
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Martins CP, Rodrigues EDC, Pedron CA, Lemos T, Oliveira LASD. Feasibility of a task-oriented training and muscle-strengthening programme to weight-bearing symmetry after stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1332681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Camilla Polonini Martins
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto da Motta (UNISUAM), Rio de Janeiro, Brasil
| | - Erika de Carvalho Rodrigues
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto da Motta (UNISUAM), Rio de Janeiro, Brasil
- Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brasil
| | - Carla Andressa Pedron
- Curso de Fisioterapia, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brasil
| | - Thiago Lemos
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto da Motta (UNISUAM), Rio de Janeiro, Brasil
| | - Laura Alice Santos de Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto da Motta (UNISUAM), Rio de Janeiro, Brasil
- Curso de Fisioterapia, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brasil
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21
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Rougier PR, Boudrahem S. Interaction between postural asymmetry and visual feedback effects in undisturbed upright stance control in healthy adults. Neurophysiol Clin 2017; 47:305-314. [PMID: 28314520 DOI: 10.1016/j.neucli.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The technique of additional visual feedback has been shown to significantly decrease the center of pressure (CP) displacements of a standing subject. Body-weight asymmetry is known to increase postural instability due to difficulties in coordinating the reaction forces exerted under each foot and is often a cardinal feature of various neurological and traumatic diseases. To examine the possible interactions between additional visual feedback and body-weight asymmetry effects, healthy adults were recruited in a protocol with and without additional visual feedback, with different levels of body-weight asymmetry. METHODS CP displacements under each foot were recorded and used to compute the resultant CP displacements (CPRes) and to estimate vertically projected center of gravity (CGv) and CPRes-CGv displacements. Overall, six conditions were randomly proposed combining two factors: asymmetry with three BW percentage distributions (50/50, 35/65 and 20/80; left/right leg) and feedback (with or without additional VFB). RESULTS The additional visual feedback technique principally reduces CGv displacements, whereas asymmetry increases CPRes-CGv displacements along the mediolateral axis. Some effects on plantar CP displacements were also observed, but only under the unloaded foot. Interestingly, no interaction between additional visual feedback and body-weight asymmetry was reported. DISCUSSION These results suggest that the various postural effects that ensue from manipulating additional visual feedback parameters, shown previously in healthy subjects in various studies, could also apply independently of the level of asymmetry. CONCLUSION Visual feedback effects could be observed in patients presenting weight-bearing asymmetries.
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Affiliation(s)
- Patrice R Rougier
- Laboratoire interdisciplinaire de biologie de la motricité, université de Savoie- Mont Blanc, domaine scientifique de Savoie-Technolac, 73376 le Bourget du Lac cedex, France.
| | - Samir Boudrahem
- Laboratoire interdisciplinaire de biologie de la motricité, université de Savoie- Mont Blanc, domaine scientifique de Savoie-Technolac, 73376 le Bourget du Lac cedex, France
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22
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Chang CC, Ku CH, Chang ST. Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: A role of crossed cerebellar diaschisis in left side. Brain Inj 2016; 31:90-97. [PMID: 27830942 DOI: 10.1080/02699052.2016.1210229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hemiplegia after stroke leads to impairment of the affected limbs and induces more weight on the non-paretic lower limb to form postural asymmetry. Studies of asymmetric cerebral functions have found similarly asymmetric functions in the cerebellum. Crossed cerebellar diaschisis (CCD) is defined as reduced blood flow and hypometabolism in the cerebellar hemisphere contralateral to supratentorial cerebral pathology. No study explored the relationship between posture (standing balance) and CCD in those persons yet. It was hypothesized that CCD would impair postural control and tend toward lateralization of cerebellar perfusion. METHODS To determine the relationship between postural asymmetry and CCD among patients with chronic stroke while testing in the upright position. Based on images from Tc-99m-ECD brain perfusion, 42 patients were retrospectively allocated into three groups: left CCD, right CCD and no CCD. The ability to maintain an upright stance as assessed by postural parameters was evaluated using a force platform. RESULTS The sway intensity differed significantly between the groups with left CCD and no CCD (p = 0.0052), as did the sway velocities (p = 0.0010). The association between the duration of stroke and sway intensity was highly significant (p < 0.0001). The interval from the stroke onset to the postural analysis was significantly associated with sway intensity and velocity. CONCLUSIONS This study indicates that the impairment of posture sway control was more severe in left CCD than the other CCD types. The results support a relationship between the postural asymmetry and lateralization of CCD in patients with chronic stroke.
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Affiliation(s)
- Cheng-Chiang Chang
- a Graduate Institute of Medical Sciences, National Defense Medical Centre , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation, School of Medicine , National Defense Medical Centre , Taipei , Taiwan.,c Department of Physical Medicine and Rehabilitation , Tri-Service General Hospital , Taipei , Taiwan
| | - Chih-Hung Ku
- d Centre for General Education , Kainan University , Taoyuan , Taiwan.,e School of Public Health, National Defense Medical Centre , Taipei , Taiwan
| | - Shin-Tsu Chang
- a Graduate Institute of Medical Sciences, National Defense Medical Centre , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation, School of Medicine , National Defense Medical Centre , Taipei , Taiwan.,f Department of Physical Medicine and Rehabilitation , Taichung Veterans General Hospital , Taichung , Taiwan
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23
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Vieira TM, Baudry S, Botter A. Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance. Front Physiol 2016; 7:158. [PMID: 27199773 PMCID: PMC4850153 DOI: 10.3389/fphys.2016.00158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/14/2016] [Indexed: 11/13/2022] Open
Abstract
Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing.
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Affiliation(s)
- Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italia; Escola de Educação Física e Desportos, Departamento de Arte Corporal, Universidade Federal do Rio de JaneiroRio de Janeiro, Brasil
| | - Stéphane Baudry
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université libre de Bruxelles Brussels, Belgium
| | - Alberto Botter
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino Torino, Italia
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Rougier PR, Bonnet CT. How providing more or less time to solve a cognitive task interferes with upright stance control; a posturographic analysis on healthy young adults. Hum Mov Sci 2016; 47:106-115. [PMID: 26949920 DOI: 10.1016/j.humov.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
Abstract
Contrasted postural effects have been reported in dual-task protocols associating balance control and cognitive task that could be explained by the nature and the relative difficulty of the cognitive task and the biomechanical significance of the force platform data. To better assess their respective role, eleven healthy young adults were required to stand upright quietly on a force platform while concomitantly solving mental-calculation or mental-navigation cognitive tasks. Various levels of difficulty were applied by adjusting the velocity rate at which the instructions were provided to the subject according to his/her maximal capacities measured beforehand. A condition without any concomitant cognitive task was added to constitute a baseline behavior. Two basic components, the horizontal center-of-gravity movements and the horizontal difference between center-of-gravity and center-of-pressures were computed from the complex center-of-pressure recorded movements. It was hypothesized that increasing the delay should infer less interaction between postural control and task solution. The results indicate that both mental-calculation and mental-navigation tasks induce reduced amplitudes for the center-of-pressure minus center-of-gravity movements, only along the mediolateral axis, whereas center-of-gravity movements were not affected, suggesting that different circuits are involved in the central nervous system to control these two movements. Moreover, increasing the delays task does not infer any effect for both movements. Since center-of-pressure minus center-of-gravity expresses the horizontal acceleration communicated to the center-of-gravity, one may assume that the control of the latter should be facilitated in dual-tasks conditions, inferring reduced center-of-gravity movements, which is not seen in our results. This lack of effect should be thus interpreted as a modification in the control of these center-of-gravity movements. Taken together, these results emphasized how undisturbed upright stance control can be impacted by mental tasks requiring attention, whatever their nature (calculation or navigation) and their relative difficulty. Depending on the provided instructions, i.e. focusing our attention on body movements or on the opposite diverting this attention toward other objectives, the evaluation of upright stance control capacities might be drastically altered.
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Affiliation(s)
- Patrice R Rougier
- Laboratoire de Physiologie de l'Exercice, EA4338, Université de Savoie, Domaine Scientifique de Savoie-Technolac, 73376 Le Bourget du Lac cedex, France.
| | - Cédrick T Bonnet
- Laboratoire de Sciences Cognitives et de Sciences Affectives, UMR CNRS 9193, Faculté de Médecine, pôle recherche, 59045 Lille, France
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25
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Souza L, Lemos T, Silva DC, de Oliveira JM, Guedes Corrêa JF, Tavares PL, Oliveira LA, Rodrigues EC, Vargas CD. Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation. Front Hum Neurosci 2016; 9:715. [PMID: 26834610 PMCID: PMC4724713 DOI: 10.3389/fnhum.2015.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/21/2015] [Indexed: 12/03/2022] Open
Abstract
Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.
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Affiliation(s)
- Lidiane Souza
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
| | - Thiago Lemos
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil
| | - Débora C Silva
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil
| | - José M de Oliveira
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - José F Guedes Corrêa
- Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - Paulo L Tavares
- Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - Laura A Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brazil
| | - Erika C Rodrigues
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil; Instituto D'Or de Pesquisa e EnsinoRio de Janeiro, Brazil
| | - Claudia D Vargas
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
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26
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Llorens R, Latorre J, Noé E, Keshner EA. Posturography using the Wii Balance Board™: A feasibility study with healthy adults and adults post-stroke. Gait Posture 2016; 43:228-32. [PMID: 26584877 DOI: 10.1016/j.gaitpost.2015.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 10/08/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posturography systems that incorporate force platforms are considered to assess balance and postural control with greater sensitivity and objectivity than conventional clinical tests. The Wii Balance Board (WBB) system has been shown to have similar performance characteristics as other force platforms, but with lower cost and size. OBJECTIVES To determine the validity and reliability of a freely available WBB-based posturography system that combined the WBB with several traditional balance assessments, and to assess the performance of a cohort of stroke individuals with respect to healthy individuals. METHODS Healthy subjects and individuals with stroke were recruited. Both groups were assessed using the WBB-based posturography system. Individuals with stroke were also assessed using a laboratory grade posturography system and a battery of clinical tests to determine the concurrent validity of the system. A group of subjects were assessed twice with the WBB-based system to determine its reliability. RESULTS A total of 144 healthy individuals and 53 individuals with stroke participated in the study. Concurrent validity with another posturography system was moderate to high. Correlations with clinical scales were consistent with previous research. The reliability of the system was excellent in almost all measures. In addition, the system successfully characterized individuals with stroke with respect to the healthy population. CONCLUSIONS The WBB-based posturography system exhibited excellent psychometric properties and sensitivity for identifying balance performance of individuals with stroke in comparison with healthy subjects, which supports feasibility of the system as a clinical tool.
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Affiliation(s)
- Roberto Llorens
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain; Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011 Valencia, Spain.
| | - Jorge Latorre
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011 Valencia, Spain
| | - Emily A Keshner
- Department of Physical Therapy, Temple University, 3307 N. Broad St., Philadelphia, PA 19140, USA
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27
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Moineau B, Boisgontier MP, Gailledrat E, De Angelis MP, Olivier I, Palluel E, Pérennou DA, Nougier V. Is standing postural control more impaired in young patients with hip-disarticulation than transfemoral amputation? A pilot study. Ann Phys Rehabil Med 2015; 58:354-6. [PMID: 26563998 DOI: 10.1016/j.rehab.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Bastien Moineau
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38700 Grenoble, France; Department of physical medicine and rehabilitation, institute of rehabilitation, Grenoble university hospital, 38130 Grenoble, France.
| | - Matthieu P Boisgontier
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38700 Grenoble, France; Movement control and neuroplasticity research group, group biomedical sciences, 3000 KU Leuven, Belgium
| | - Elodie Gailledrat
- Department of physical medicine and rehabilitation, institute of rehabilitation, Grenoble university hospital, 38130 Grenoble, France
| | - Marie-Pierre De Angelis
- Department of physical medicine and rehabilitation, institute of rehabilitation, Grenoble university hospital, 38130 Grenoble, France
| | | | - Estelle Palluel
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38700 Grenoble, France
| | - Dominic A Pérennou
- Department of physical medicine and rehabilitation, institute of rehabilitation, Grenoble university hospital, 38130 Grenoble, France
| | - Vincent Nougier
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38700 Grenoble, France
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28
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Mansfield A, Inness EL. Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation. Rehabil Process Outcome 2015. [DOI: 10.4137/rpo.s20363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Assessment of balance control is essential to guide physical rehabilitation poststroke. However, current observational assessment tools available to physiotherapists provide limited information about underlying dyscontrol. This paper describes a force plate-based assessment of quiet standing balance control that we have implemented for individuals attending inpatient stroke rehabilitation. The assessment uses two force plates to measure location of ground reaction forces to maintain stability in quiet standing in five conditions (eyes open, eyes closed, standing symmetrically, and maximal loading on the less-affected and more-affected limbs). Measures of interest are variability of the centers of pressure under each foot and both feet combined, weight-bearing asymmetry, and correlation of center of pressure fluctuations between limbs. We present representative values for the above-mentioned measures and case examples to illustrate how the assessment can reveal patient-specific balance control problems and direct treatment. We identify limitations to our current assessment and recommendations for future research.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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29
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Liuzzo DM, Peters DM, Middleton A, Lanier W, Chain R, Barksdale B, Fritz SL. Measurements of Weight Bearing Asymmetry Using the Nintendo Wii Fit Balance Board Are Not Reliable for Older Adults and Individuals With Stroke. J Geriatr Phys Ther 2015; 40:37-41. [PMID: 26288237 DOI: 10.1519/jpt.0000000000000065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clinicians and researchers have used bathroom scales, balance performance monitors with feedback, postural scale analysis, and force platforms to evaluate weight bearing asymmetry (WBA). Now video game consoles offer a novel alternative for assessing this construct. By using specialized software, the Nintendo Wii Fit balance board can provide reliable measurements of WBA in healthy, young adults. However, reliability of measurements obtained using only the factory settings to assess WBA in older adults and individuals with stroke has not been established. PURPOSE To determine whether measurements of WBA obtained using the Nintendo Wii Fit balance board and default settings are reliable in older adults and individuals with stroke. METHODS Weight bearing asymmetry was assessed using the Nintendo Wii Fit balance board in 2 groups of participants-individuals older than 65 years (n = 41) and individuals with stroke (n = 41). Participants were given a standardized set of instructions and were not provided auditory or visual feedback. Two trials were performed. Intraclass correlation coefficients (ICC), standard error of measure (SEM), and minimal detectable change (MDC) scores were determined for each group. RESULTS The ICC for the older adults sample was 0.59 (0.35-0.76) with SEM95 = 6.2% and MDC95 = 8.8%. The ICC for the sample including individuals with stroke was 0.60 (0.47-0.70) with SEM95 = 9.6% and MDC95 = 13.6%. DISCUSSION Although measurements of WBA obtained using the Nintendo Wii Fit balance board, and its default factory settings, demonstrate moderate reliability in older adults and individuals with stroke, the relatively high associated SEM and MDC values substantially reduce the clinical utility of the Nintendo Wii Fit balance board as an assessment tool for WBA. CONCLUSIONS Weight bearing asymmetry cannot be measured reliably in older adults and individuals with stroke using the Nintendo Wii Fit balance board without the use of specialized software.
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Affiliation(s)
- Derek M Liuzzo
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia
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30
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Abujaber S, Gillispie G, Marmon A, Zeni J. Validity of the Nintendo Wii Balance Board to assess weight bearing asymmetry during sit-to-stand and return-to-sit task. Gait Posture 2015; 41:676-82. [PMID: 25715680 PMCID: PMC4385456 DOI: 10.1016/j.gaitpost.2015.01.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 02/02/2023]
Abstract
Weight bearing asymmetry is common in patients with unilateral lower limb musculoskeletal pathologies. The Nintendo Wii Balance Board (WBB) has been suggested as a low-cost and widely-available tool to measure weight bearing asymmetry in a clinical environment; however no study has evaluated the validity of this tool during dynamic tasks. Therefore, the purpose of this study was to determine the concurrent validity of force measurements acquired from the WBB as compared to laboratory force plates. Thirty-five individuals before, or within 1 year of total joint arthroplasty performed a sit-to-stand and return-to-sit task in two conditions. First, subjects performed the task with both feet placed on a single WBB. Second, the task was repeated with each foot placed on an individual laboratory force plate. Peak vertical ground reaction force (VGRF) under each foot and the inter-limb symmetry ratio were calculated. Validity was examined using Intraclass Correlation Coefficients (ICC), regression analysis, 95% limits of agreement and Bland-Altman plots. Force plates and the WBB exhibited excellent agreement for all outcome measurements (ICC=0.83-0.99). Bland-Altman plots showed no obvious relationship between the difference and the mean for the peak VGRF, but there was a consistent trend in which VGRF on the unaffected side was lower and VGRF on the affected side was higher when using the WBB. However, these consistent biases can be adjusted for by utilizing regression equations that estimate the force plate values based on the WBB force. The WBB may serve as a valid, suitable, and low-cost alternative to expensive, laboratory force plates for measuring weight bearing asymmetry in clinical settings.
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Affiliation(s)
- Sumayeh Abujaber
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States,Department of Physiotherapy, Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Gregory Gillispie
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Adam Marmon
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Joseph Zeni
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States,Department of Physical Therapy, University of Delaware, Newark, DE, United States
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Cano-de-la-Cuerda R, Molero-Sánchez A, Carratalá-Tejada M, Alguacil-Diego I, Molina-Rueda F, Miangolarra-Page J, Torricelli D. Theories and control models and motor learning: Clinical applications in neurorehabilitation. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2011.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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32
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Yang YR, Chen YH, Chang HC, Chan RC, Wei SH, Wang RY. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil 2014; 29:987-93. [DOI: 10.1177/0269215514564898] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022]
Abstract
Objective: We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Design: Assessor-blinded, pilot randomized controlled study. Participants: A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group ( N = 7, computer-generated interactive visual feedback training) or control group ( N = 5, mirror visual feedback training). Main outcome measures: The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. Results: A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ±1.1 and 1.4 ±1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ±4.3 and 7.2 ±1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ±2.2 and 5.6 ±3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome ( p < 0.01) and balance ( p < 0.05) compared with the mirror visual feedback training program. Conclusions: Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training.
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Affiliation(s)
- Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hua Chen
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Heng-Chih Chang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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Gasq D, Labrunée M, Amarantini D, Dupui P, Montoya R, Marque P. Between-day reliability of centre of pressure measures for balance assessment in hemiplegic stroke patients. J Neuroeng Rehabil 2014; 11:39. [PMID: 24649845 PMCID: PMC3999988 DOI: 10.1186/1743-0003-11-39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/17/2014] [Indexed: 12/05/2022] Open
Abstract
Background Stroke patients have impaired postural balance that increases the risk of falls and impairs their mobility. Assessment of postural balance is commonly carried out by recording centre of pressure (CoP) displacements, but the lack of data concerning reliability of these measures compromises their interpretation. The purpose of this study was to investigate the between-day reliability of six CoP-based variables, in order to provide i) reliability data for monitoring postural sway and weight-bearing asymmetry of stroke patients in clinical practice and ii) consistent assessment method of measurement error for applications in physical medicine and rehabilitation. Methods Postural balance of 20 stroke patients was assessed in quiet standing on a force platform, in two sessions, 7 days apart. Six CoP-based variables were collected in eyes open and eyes closed conditions: postural sway was assessed with mean and standart deviation of CoP-velocity, CoP-velocity along the mediolateral and anteroposterior axes, and confidence ellipse area (CEAREA); weight-bearing asymmetry was assessed with mean CoP position along the mediolateral axis (CoPML). The intraclass correlation coefficient (ICC) was used to determine the level of agreement between test-retest. Small real difference (SRD), corresponding to the smallest change that indicates a real improvement for a single individual, was used to determine the extent of measurement error. Results ICCs were satisfactory (>0.9) for all CoP-based variables, except for CEAREA in eyes open condition and CoPML (<0.8). The SRDs (eyes open/closed conditions) were: 6.1/9.5 mm.s-1 for mean velocity; 12.3/12.2 mm.s-1 for standard deviation of CoP-velocity; 3.6/5.5 mm.s-1 and 4.9/7.3 mm.s-1 for CoP-velocity in mediolateral and anteroposterior axes, respectively; 17.4/21.4 mm for CoPML. Because CEAREA showed heteroscedasticity of measurement error distribution, SRD (eyes open/closed conditions) was expressed as a percentage (121/75%) and a ratio (3.68/2.16) obtained after log-antilog procedure. Conclusions In clinical practice, the CoP-based velocity variables should be prefer to CEAREA to assess and monitor postural sway over time in hemiplegic stroke patients. The poor reliability of CoPML compromises its use to assess weight-bearing asymmetry. The procedure we used could be applied in reliability studies concerning other CoP-based variables or other biological variables in the field of physical medicine and rehabilitation.
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Affiliation(s)
- David Gasq
- Explorations Fonctionnelles Physiologiques, CHU Toulouse Rangueil, Avenue du Pr Jean Poulhès, 31059 Toulouse, France.
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Bourlon C, Lehenaff L, Batifoulier C, Bordier A, Chatenet A, Desailly E, Fouchard C, Marsal M, Martinez M, Rastelli F, Thierry A, Bartolomeo P, Duret C. Dual-tasking postural control in patients with right brain damage. Gait Posture 2014; 39:188-93. [PMID: 23916691 DOI: 10.1016/j.gaitpost.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/30/2013] [Accepted: 07/01/2013] [Indexed: 02/02/2023]
Abstract
The control of dual-tasking effects is a daily challenge in stroke neurorehabilitation. It maybe one of the reasons why there is poor functional prognosis after a stroke in the right hemisphere, which plays a dominant role in posture control. The purpose of this study was to explore cognitive motor interference in right brain-lesioned and healthy subjects maintaining a standing position while performing three different tasks: a control task, a simple attentional task and a complex attentional task. We measured the sway area of the subjects on a force platform, including the center of pressure and its displacements. Results showed that stroke patients presented a reduced postural sway compared to healthy subjects, who were able to maintain their posture while performing a concomitant attentional task in the same dual-tasking conditions. Moreover, in both groups, the postural sway decreased with the increase in attentional load from cognitive tasks. We also noticed that the stability of stroke patients in dual-tasking conditions increased together with the weight-bearing rightward deviation, especially when the attentional load of the cognitive tasks and lower limb motor impairments were high. These results suggest that stroke patients and healthy subjects adopt a similar postural regulation pattern aimed at maintaining stability in dual-tasking conditions involving a static standing position and different attention-related cognitive tasks. Our results indicate that attention processes might facilitate static postural control.
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Affiliation(s)
- Clémence Bourlon
- Service de Rééducation et de Réadaptation Fonctionnelle, Clinique Les Trois Soleils, Boissise le Roi, France.
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Kumar SNS, Omar B, Htwe O, Joseph LH, Krishnan J, Esfehani AJ, Min LL. Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement. ACTA ACUST UNITED AC 2014; 51:591-8. [DOI: 10.1682/jrrd.2013.07.0166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/16/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Senthil N. S. Kumar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Baharudin Omar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ohnmar Htwe
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Jagannathan Krishnan
- Faculty of Chemical Engineering, MARA University of Technology, Shah Alam, Malaysia
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Is weight-bearing asymmetry associated with postural instability after stroke? A systematic review. Stroke Res Treat 2013; 2013:692137. [PMID: 23738232 PMCID: PMC3655651 DOI: 10.1155/2013/692137] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/28/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Improvement of postural stability is an important goal during poststroke rehabilitation. Since weight-bearing asymmetry (WBA) towards the nonparetic leg is common, training of weight-bearing symmetry has been a major focus in post-stroke balance rehabilitation. It is assumed that restoration of a more symmetrical weight distribution is associated with improved postural stability. Objective. To determine to what extent WBA is associated with postural instability in people after stroke. Methods. Electronic databases were searched (Cochrane, MEDLINE, EMBASE, and CINAHL) until March 2012. Main Eligibility Criteria. (1) Participants were people after stroke. (2) The association between WBA and postural stability was reported. Quality of reporting was assessed with the STROBE checklist and a related tool for reporting of confounding. Results. Nine observational studies met all criteria. Greater spontaneous WBA was associated with higher center of pressure (COP) velocity and with poorer synchronization of COP trajectories between the legs (two and one studies, resp.). Evidence for associations between WBA and performance on clinical balance tests or falls was weak. Conclusion. Greater WBA after stroke was associated with increased postural sway, but the current literature does not provide evidence for a causal relationship. Further studies should investigate whether reducing WBA would improve postural stability.
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Lu RR, Li F, Wu Y, Hu YS, Xu XL, Zou RL, Hu XF. Demonstration of posturographic parameters of squat-stand activity in hemiparetic patients on a new multi-utility balance assessing and training system. J Neuroeng Rehabil 2013; 10:37. [PMID: 23587150 PMCID: PMC3641010 DOI: 10.1186/1743-0003-10-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Quantitative evaluation of position control ability in stroke patients is needed. Here we report a demonstration of position control ability assessment and test-retest reliability during squat-stand activity on a new system in hemiparetic patients and controls. Methods Sixty-two healthy adults and thirty-four hemiparetics were enrolled. All of the participants were required to complete five repeated squat-stand activities under three different conditions: partial weight support, standard weight bearing, and resistance. The healthy adults’ test was repeated twice to assess the reliability, while the hemiparetics were tested one time to assess impairments in their position control ability. The healthy participants completed their second test 1 wk after the first. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability. Results During partial weight support, the ICCs ranged from 0.77 to 0.91, which indicated a good reliability. During standard weight bearing and resistance, the ICCs varied from 0.64 to 0.86 and 0.54 to 0.84, respectively, indicating a fair reliability. Compared with the healthy adults, the stroke patients demonstrated poorer position control ability. Conclusions The posturography of the squat-stand activity is a new and reliable measurement tool for position control. According to the methods proposed here, hemiparetics can be differentiated from healthy adults using the squat-stand activity. This activity will provide a new evaluation tool and therapy with visual feedback for the stroke patients. Trial registration Chinese clinical trial registry, ChiCTR-TRC-10000863
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Panwalkar N, Aruin AS. Role of ankle foot orthoses in the outcome of clinical tests of balance. Disabil Rehabil Assist Technol 2012; 8:314-20. [DOI: 10.3109/17483107.2012.721158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mohapatra S, Eviota AC, Ringquist KL, Muthukrishnan SR, Aruin AS. Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke. ISRN REHABILITATION 2012; 2012. [PMID: 25530888 PMCID: PMC4269244 DOI: 10.5402/2012/328018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of individuals with stroke. CBWS involves a forced shift of body weight towards a person's affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. METHODS Eleven patients with acute stroke were randomly assigned to experimental and control groups. The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg's Balance, and Fugl-Meyer's Scores were recorded before and after the intervention. RESULTS Weight bearing on the affected side increased in the experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the groups (P < 0.05). However, experimental group (P = 0.01) demonstrated larger improvements in gait velocity compared to the control group (P = 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups. CONCLUSION The implementation of a two-week intervention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke. The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke.
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Affiliation(s)
- Sambit Mohapatra
- Department of Physical Therapy, University of Illinois at Chicago, 1919 West Taylor Street (MC 898), Chicago, IL 60612, USA
| | - Aileen C Eviota
- Department of Physical Therapy, University of Illinois at Chicago Medical Center, Chicago, IL 60612, USA
| | - Keir L Ringquist
- Department of Physical Therapy, University of Illinois at Chicago Medical Center, Chicago, IL 60612, USA
| | - Sri Ranjini Muthukrishnan
- Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alexander S Aruin
- Department of Physical Therapy, University of Illinois at Chicago, 1919 West Taylor Street (MC 898), Chicago, IL 60612, USA
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Theories and control models and motor learning: clinical applications in neuro-rehabilitation. Neurologia 2012; 30:32-41. [PMID: 22341985 DOI: 10.1016/j.nrl.2011.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/09/2011] [Accepted: 12/20/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In recent decades there has been a special interest in theories that could explain the regulation of motor control, and their applications. These theories are often based on models of brain function, philosophically reflecting different criteria on how movement is controlled by the brain, each being emphasised in different neural components of the movement. The concept of motor learning, regarded as the set of internal processes associated with practice and experience that produce relatively permanent changes in the ability to produce motor activities through a specific skill, is also relevant in the context of neuroscience. Thus, both motor control and learning are seen as key fields of study for health professionals in the field of neuro-rehabilitation. DEVELOPMENT The major theories of motor control are described, which include, motor programming theory, systems theory, the theory of dynamic action, and the theory of parallel distributed processing, as well as the factors that influence motor learning and its applications in neuro-rehabilitation. CONCLUSIONS At present there is no consensus on which theory or model defines the regulations to explain motor control. Theories of motor learning should be the basis for motor rehabilitation. The new research should apply the knowledge generated in the fields of control and motor learning in neuro-rehabilitation.
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Guillebastre B, Rougier PR, Sibille B, Chrispin A, Detante O, Pérennou DA. When might a cane be necessary for walking following a stroke? Neurorehabil Neural Repair 2011; 26:173-7. [PMID: 21734069 DOI: 10.1177/1545968311412786] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For individuals with lateral postural imbalance after stroke, the decision to adopt a cane for walking often is not based on objective findings. OBJECTIVE The authors investigated the explanatory value of 2 posturographic criteria for lateral postural imbalance on the walking abilities of poststroke subjects. METHODS Indices of postural asymmetry (percentage of body weight on the less loaded lower limb) and instability (mediolateral variance of center-of-pressure displacements) were measured in 40 healthy individuals and 52 patients (mean 94.2 days after first hemispheric stroke), who stood still on a double force platform. Cut-off values (mean ± 2 standard deviations) were calculated and compared. The predictive value of both postural indices on walking abilities with or without a cane was analyzed. RESULTS Of the patients, 34.6% were unstable along the mediolateral axis (variance >7 mm(2)), and 44.2% were asymmetrical (body weight <40%); 30% needed a technical aid and 35% walked without a cane. The probability of being able to walk without a cane was less than 5% if the paretic lower limb was not loaded more than 40%. The postural instability index was less informative. CONCLUSIONS This study suggests that patients who do not load more than 40% of their body weight on their paretic lower limb may benefit from the prescription of a cane.
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Affiliation(s)
- Bastien Guillebastre
- Université de Savoie, Domaine Universitaire du Bourget-du-Lac, Bourget-du-Lac, France
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Martins EF, de Araujo Barbosa PHF, de Menezes LT, de Sousa PHC, Costa AS. Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis? Physiother Theory Pract 2011; 27:566-71. [PMID: 21721993 DOI: 10.3109/09593985.2011.552312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.
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Clark RA, McGough R, Paterson K. Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards. Gait Posture 2011; 34:288-91. [PMID: 21570290 DOI: 10.1016/j.gaitpost.2011.04.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/25/2011] [Accepted: 04/19/2011] [Indexed: 02/02/2023]
Abstract
Weight bearing asymmetry (WBA) during dynamic tasks is prevalent in a variety of clinical populations. However, accurate measurement has previously been out of reach of the clinician due to the costly equipment and technical expertise required. The aim of this study was to assess the test-retest reliability of WBA data obtained using an inexpensive and simple to use dual force plate system incorporating unmodified Nintendo Wii Balance Boards (NWBB) and customized software. A secondary outcome measure, individual limb COP path velocity, which represents the postural sway under each limb was also examined. Twenty-three participants performed squats both with and without visual WBA feedback on two separate occasions. Weight-bearing asymmetry as a percentage of body mass and individual limb center of pressure (COP) path velocity were recorded during these trials, with intraclass correlation coefficient (ICC(2,1)) analysis performed to assess test-retest reliability. This system provided reliable values for both outcome measures when performed with and without real-time visual feedback of WBA (ICC(2,1) range=0.75-0.91). In conclusion, recording WBA and COP path velocity data using NWBB is reliable. Given that tens of millions of NWBB have been sold worldwide, and that reprogramming them for clinical purposes is within the reach of most software developers, similar systems may soon become commonplace in the clinical setting.
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Affiliation(s)
- Ross Allan Clark
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, 202 Berkeley Street, Parkville, VIC 3010, Australia.
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Kiyota Y, Hase K, Nagashima H, Obara T, Liu M. Adaptation process for standing postural control in individuals with hemiparesis. Disabil Rehabil 2011; 33:2567-73. [DOI: 10.3109/09638288.2011.579226] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mansfield A, Danells CJ, Inness E, Mochizuki G, McIlroy WE. Between-limb synchronization for control of standing balance in individuals with stroke. Clin Biomech (Bristol, Avon) 2011; 26:312-7. [PMID: 21055854 DOI: 10.1016/j.clinbiomech.2010.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND During standing, forces and moments exerted at the feet serve to maintain stability in the face of constant centre-of-mass movement. These actions are temporally synchronized in healthy individuals. Stroke is typically a unilateral injury resulting in increased sensori-motor impairment in the contra-lesional compared with the ipsi-lesional lower-limb, which could lead to reduced between-limb synchronization for control of standing balance. The purpose of this study is to investigate between-limb synchronization of standing balance control in individuals with stroke; a potentially important index of control of upright stability. METHODS Twenty healthy controls and 33 individuals with unilateral stroke were assessed. Stability was assessed during a 30-second quiet standing trial by measuring data from two force plates (one per foot). Limb-specific centre of pressure was calculated. Between-limb synchronization was defined as the coefficient of the correlation between the left and right foot for both the antero-posterior and medio-lateral centre of pressure time series. Synchronization, weight-bearing symmetry, and root mean square of the total centre of pressure excursion were compared between controls and stroke participants. FINDINGS Stroke participants swayed more, were more asymmetric, and had less between-limb synchronization than healthy controls. Among individuals with stroke, reduced between-limb synchronization was related to increased postural sway in the medio-lateral direction and increased weight-bearing asymmetry. INTERPRETATION Individuals with stroke have reduced temporal synchronization of centre of pressure fluctuations under the feet when controlling quiet standing. The clinical significance of reduced synchronization remains to be determined, although it appears linked to increased medio-lateral sway and weight-bearing asymmetry.
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Affiliation(s)
- Avril Mansfield
- Heart and Stroke Foundation of Ontario Centre for Stroke Recovery, Canada.
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Oliveira CB, Medeiros ÍRT, Greters MG, Frota NAF, Lucato LT, Scaff M, Conforto AB. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke. Clinics (Sao Paulo) 2011; 66:2043-8. [PMID: 22189728 PMCID: PMC3226598 DOI: 10.1590/s1807-59322011001200008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/23/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Impairments in balance can be a consequence of changes in the motor, sensory, and integrative aspects of motor control. Abnormal sensory reweighting, i.e., the ability to select the most appropriate sensory information to achieve postural stability, may contribute to balance impairment. The Sensory Organization Test is a component of Computerized Dynamic Posturography that evaluates the impact of visual, vestibular, and somatosensory inputs, as well as sensory reweighting, under conditions of sensory conflict. The aim of this study is to compare balance control in hemiparetic patients during the first year post-stroke and in age-matched neurologically normal subjects using the Berg Balance Scale and Computerized Dynamic Posturography. METHODS We compared the Berg Balance Scale and Sensory Organization Test scores in 21 patients with hemiparesis after first-ever ischemic stroke and in 21 age-matched, neurologically normal subjects. An equilibrium score was defined for each Sensory Organization Test condition. RESULTS Berg Balance Scale scores were significantly lower in the patients than in the neurologically normal subjects. Equilibrium scores were significantly lower in the patients than in the neurologically normal subjects for those Sensory Organization Test conditions that did not provide appropriate somatosensory information and under conditions of sensory conflict. A history of falls was more frequent in patients with lower equilibrium scores. CONCLUSION During the first year after a stroke, defective sensory reweighting significantly impacts balance control in hemiparetic patients. These results are important for the planning of effective rehabilitation interventions.
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Rougier PR, Genthon N. Dynamical assessment of weight-bearing asymmetry during upright quiet stance in humans. Gait Posture 2009; 29:437-43. [PMID: 19070493 DOI: 10.1016/j.gaitpost.2008.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 10/27/2008] [Accepted: 11/03/2008] [Indexed: 02/02/2023]
Abstract
Distributing asymmetrically the body weight (BW) has been previously described through static parameters such as the mean position of the resultant centre of pressure (CP(Res)) along the medio-lateral axis or mean BW distribution on the two legs. However, neither the respective dynamic contribution of each leg in the CP(Res) displacements nor the role of an ankle mechanism and a load/unload hip mechanism was established. The main goal of this study is to investigate whether asymmetric postural control can be better assessed through such information. To this aim, 14 healthy adults were required to stand with or without weight-bearing asymmetry. The recorded CP(Res) trajectories were re-computed by substituting for each time the average value of the left or the right foot plantar CP trajectory. The contribution of ankle and hip mechanisms, consisting in modifying either the pressure distribution under the feet or the loading-unloading of the BW on each leg, respectively, was also assessed through an identical substitution principle. Distributing asymmetrically the BW reinforces the contribution of the CP displacements under the loaded foot in the generated CP(Res) movements, especially along the antero-posterior axis. The predominant role played by the ankle mechanisms, observed along the antero-posterior axis, is significantly decreased by the BW asymmetry. The reduced correlations with the traditional parameters used for characterizing BW asymmetry along the medio-lateral axis let suggest that this novel approach could be useful to differently assess the effects on postural control of a BW asymmetrically distributed in normal and impaired individuals.
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Affiliation(s)
- P R Rougier
- UFR CISM, Université de Savoie, Le Bourget du Lac, France.
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Rougier PR. What insights can be gained when analysing the resultant centre of pressure trajectory? Neurophysiol Clin 2008; 38:363-73. [DOI: 10.1016/j.neucli.2008.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 09/21/2008] [Indexed: 01/18/2023] Open
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