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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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Yang DJ, Park SK, Uhm YH, Park SH, Chun DW, Kim JH. The correlation between muscle activity of the quadriceps and balance and gait in stroke patients. J Phys Ther Sci 2016; 28:2289-92. [PMID: 27630416 PMCID: PMC5011580 DOI: 10.1589/jpts.28.2289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the correlation between quadriceps
muscle activity and balance and gait in stroke patients. [Subjects and Methods] Fifty-five
stroke patients (30 males 25 females; mean age 58.7 years; stroke duration 4.82 months;
Korean mini-mental state examination score 26.4) participated in this study. MP100 surface
electromyography, BioRescue, and LUKOtronic were used to measure the quadriceps muscle
activity, balance, and gait, respectively. [Results] There was a significant correlation
between quadriceps muscle activity (vastus lateralis % reference voluntary contraction,
vastus medialis % reference voluntary contraction) and balance (limits of stability) and
gait (gait velocity) but there was none between vastus lateralis % reference voluntary
contraction, vastus medialis % reference voluntary contraction. [Conclusion] An increase
in quadriceps muscle activity will improve balance and gait ability. To improve function
in stroke patients, training is needed to strengthen the quadriceps muscles.
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Affiliation(s)
- Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Sam Heon Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Dong Whan Chun
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
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Park SK, Yang DJ, Uhm YH, Heo JW, Kim JH. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients. J Phys Ther Sci 2016; 28:2055-8. [PMID: 27512263 PMCID: PMC4968505 DOI: 10.1589/jpts.28.2055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effect of virtual reality-based
eccentric training on lower extremity muscle activity and balance in stroke patients.
[Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to
each of two eccentric training groups: one using a slow velocity (group I) and one using a
fast velocity (group II). The virtual reality-based eccentric training was performed by
the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron
system. Surface electromyography was used to measure the lower extremity muscle activity,
while a BioRescue was used to measure balancing ability. [Results] A significant
difference in lower extremity muscle activation and balance ability was observed in group
I compared with group II. [Conclusion] This study showed that virtual reality-based
eccentric training using a slow velocity is effective for improving lower extremity muscle
activity and balance in stroke patients.
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Affiliation(s)
- Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Jae Won Heo
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
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Elhinidi EIM, Ismaeel MMI, El-Saeed TM. Effect of dual-task training on postural stability in children with infantile hemiparesis. J Phys Ther Sci 2016; 28:875-80. [PMID: 27134376 PMCID: PMC4842457 DOI: 10.1589/jpts.28.875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/11/2015] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The aim of this study was to evaluate the influence of using a selected
dual-task training program to improve postural stability in infantile hemiparesis.
[Subjects and Methods] Thirty patients participated in this study; patients were
classified randomly into two equal groups: study and control groups. Both groups received
conventional physical therapy treatment including mobility exercises, balance exercises,
gait training exercises, and exercises to improve physical conditioning. In addition, the
study group received a selected dual-task training program including balance and cognitive
activities. The treatment program was conducted thrice per week for six successive weeks.
The patients were assessed with the Biodex Balance System. These measures were recorded
two times: before the application of the treatment program (pre) and after the end of the
treatment program (post). [Results] There was a significant improvement for both groups;
the improvement was significantly higher in the study group compared to the control group.
[Conclusion] The selected dual-task training program is effective in improving postural
stability in patients with infantile hemiparesis when added to the conventional physical
therapy program.
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Affiliation(s)
- Elbadawi Ibrahim Mohammad Elhinidi
- Department of Physical Therapy for Neuromuscular Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Egypt; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Aljouf University, Saudi Arabia
| | - Marwa Mostafa Ibrahim Ismaeel
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Aljouf University, Saudi Arabia
| | - Tamer Mohamed El-Saeed
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
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Park GD, Choi JU, Kim YM. The effects of multidirectional stepping training on balance, gait ability, and falls efficacy following stroke. J Phys Ther Sci 2016; 28:82-6. [PMID: 26957733 PMCID: PMC4755979 DOI: 10.1589/jpts.28.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to determine whether a multidirectional stepping
training improves balance, gait ability, and falls efficacy in stroke patients. [Subjects]
Firty patients who met the selection criteria and agreed to participate in research at
hospital N were randomly allocated and enrolled in this study. Twenty of the subjects were
assigned to an experimental group that participated in combined stepping exercise, and the
other twenty subjects were assigned to a control group that received general physical
therapy. [Methods] In the two groups, balance was measured using the Berg Balance Scale,
gait ability was measured using the 10-m Walk Test, and falls efficacy was measured using
the Falls Efficacy Scale before training and after 6 weeks of training. [Results]
Comparative analysis of the experimental group’s pretest and post-test results showed
statistically significant differences in the Berg Balance Scale, 10-m Walk Test, and Falls
Efficacy Scale scores. There were significant between-group differences in the Berg
Balance Scale, 10-m Walk Test, and Falls Efficacy Scale scores. [Conclusion] The results
suggest that a combined stepping exercise can be an effective intervention to improve the
balance, gait ability, and falls efficacy in stroke patients.
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Affiliation(s)
- Gi-Deok Park
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Jin-Uk Choi
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu University, Republic of Korea
| | - Young-Min Kim
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
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Cho K, Yu J, Rhee H. Risk factors related to falling in stroke patients: a cross-sectional study. J Phys Ther Sci 2015; 27:1751-3. [PMID: 26180313 PMCID: PMC4499976 DOI: 10.1589/jpts.27.1751] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate a comprehensive understanding of the factors associated with falls in poststroke patients. [Subjects] Forty-eight stroke patients (22 males and 26 females; age 63.79 years) participated in this study. [Methods] This study applied a cross-sectional design. Fear of falling [Falls Efficacy Scale (FES)], balance function [Berg Balance Scale (BBS) and Modified Rivermead Mobility Index (MRMI)], ADL performance level [Modified Barthel Index (MBI)] and cognitive function [Loewenstein Occupational Therapy Cognitive Assessment for Geriatric Populations (LOTCA-G)] were assessed. [Results] Falls efficacy was moderately correlated with ADL performance, balance, and cognition. In addition, stepwise linear regression analysis revealed that ADL performance was the explanatory variable closely associated with falls efficacy in stroke patients. [Conclusion] ADL performance was the primary explanatory variable of falls efficacy according to regression analysis. Thus, we suggest that these results may be used as basic data for developing rehabilitation programs for prevention of falls in stroke patients.
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Affiliation(s)
- Kihun Cho
- Department of Rehabilitative and Assistive Technology, Korea National Rehabilitation Research Institute, Republic of Korea
| | - Jaeho Yu
- Department of Physical Therapy, Sun Moon University, Republic of Korea
| | - Hyeonsook Rhee
- Department of Occupational Therapy, Shin Sung University, Republic of Korea
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Ki KI, Kim MS, Moon Y, Choi JD. Effects of auditory feedback during gait training on hemiplegic patients' weight bearing and dynamic balance ability. J Phys Ther Sci 2015; 27:1267-9. [PMID: 25995603 PMCID: PMC4434024 DOI: 10.1589/jpts.27.1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of auditory feedback during gait on the weight
bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic
patients participated in this experiment and they were randomly allocated to an
experimental group and a control group. [Methods] Both groups received neuro-developmental
treatment for four weeks and the experimental group additionally received auditory
feedback during gait training. In order to examine auditory feedback effects on weight
bearing during gait, a motion analysis system GAITRite was used to measure the duration of
the stance phase and single limb stance phase of the subjects. [Results] The experimental
group showed statistically significant improvements in the duration of the stance phase
and single limb stance phase of the paretic side and the results of the Timed Up and Go
Test after the training. [Conclusion] Auditory feedback during gait training significantly
improved the duration of the stance phase and single limb stance phase of hemiplegic
stroke patients.
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Affiliation(s)
- Kyong-Il Ki
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Mi-Sun Kim
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Young Moon
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Jong-Duk Choi
- Department of Physical Therapy, College of Natural Science, Daejeon University, Republic of Korea
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Cho K, Lee K, Lee B, Lee H, Lee W. Relationship between Postural Sway and Dynamic Balance in Stroke Patients. J Phys Ther Sci 2014; 26:1989-92. [PMID: 25540514 PMCID: PMC4273074 DOI: 10.1589/jpts.26.1989] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of the current study was to investigate the relationship between
postural sway and dynamic balance in post stroke patients. [Subjects] Thirty-one stroke
patients (20 men and 11 women; age 64.25 years; stroke duration 12.70 months; MMSE-K score
26.35) participated in this study. [Methods] This study applied a cross-sectional design.
A Good Balance system was used for measurement of the postural sway velocity
(anteroposterior and mediolateral) and velocity moment of subjects under the eyes open and
eyes closed conditions in a standing posture. The postural sway of subjects was measured
under two surface conditions (stable and unstable surfaces). [Results] On the unstable
surface (foam), no significant correlation was observed between postural sway and dynamic
balance except for the berg balance scale (BBS) score and anteroposterior postural sway
velocity under the eyes open condition, anteroposterior postural sway velocity under the
eyes closed condition, and postural sway velocity moment. In addition, in the stable
condition, no significant correlation was observed between postural sway and dynamic
balance. [Conclusion] Our results indicate that a decrease in postural sway does not
necessarily reflect improvement of dynamic balance ability. We believe that this finding
may be useful in balance rehabilitation for prevention of falls after a stroke.
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Affiliation(s)
- Kihun Cho
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Research Institute, Republic of Korea
| | - Kyoungsuk Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Byungjoon Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Hwangjae Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Wanhee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Yanohara R, Teranishi T, Tomita Y, Tanino G, Ueno Y, Sonoda S. Recovery process of standing postural control in hemiplegia after stroke. J Phys Ther Sci 2014; 26:1761-5. [PMID: 25435695 PMCID: PMC4242950 DOI: 10.1589/jpts.26.1761] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the recovery process of standing postural control in hemiplegia after stroke. [Subjects and Methods] Thirty-four inpatients with hemiparesis after first-onset stroke were included in this study. We measured the center of pressure fluctuations during quiet standing using a force platform at 2, 4, and 6 weeks after admission. We assessed weight-bearing asymmetry, and velocity and amplitude of body sway. [Results] Weight-bearing asymmetry diminished in the first 2 weeks of observation. Velocity of body sway also decreased significantly in the first 2 weeks, though its amplitude only decreased significantly after 4 weeks of observation. [Conclusion] Amplitude of body sway requires a longer time for significant improvement than weight-bearing asymmetry and velocity of body sway. Although the loading function of the paretic lower limb improved at an early stage, attainment of optimum postural control, including management of the affected paretic lower limb, requires much time.
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Affiliation(s)
- Ryuzo Yanohara
- Fujita Health University Nanakuri Sanatorium: 424-1 Ohdori, Tsu, Mie 514-1295, Japan
| | | | - Yutaka Tomita
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
| | - Genichi Tanino
- Fujita Health University Nanakuri Sanatorium: 424-1 Ohdori, Tsu, Mie 514-1295, Japan ; Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
| | - Yoshiya Ueno
- Fujita Health University Nanakuri Sanatorium: 424-1 Ohdori, Tsu, Mie 514-1295, Japan
| | - Shigeru Sonoda
- Fujita Health University Nanakuri Sanatorium: 424-1 Ohdori, Tsu, Mie 514-1295, Japan ; Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
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