Contribution of Each Lower Limb to Upright Standing in Stroke Patients

Abstract

Background and Purpose-To analyze the postural behavior of standing stroke patients: (1) To differentiate between postural impairment attributable to the neurological condition (deficits attributable to the cerebral lesion) and postural impairment attributable to new mechanical constraints caused by body weight asymmetry; (2) To assess the involvement of each limb in the postural impairment; (3) To better understand which clinical deficits underlie the postural impairment. Methods-The posturographic characteristics of each limb in 41 stroke patients (first hemispheric stroke: 16 left, 25 right cerebral lesions) required to stand in their preferred posture were compared to those in 40 matched healthy individuals required to stand asymmetrically. Results-Compared to normal individuals in a similar asymmetrical posture, stroke patients were more unstable. The weight bearing asymmetry and the lateral postural instability were mainly related to spatial neglect. The paretic limb was unable to bring into play a normal longitudinal pattern of the center of pressure, which reflects an impaired stabilization control. Overall postural instability occurred when the strong limb was unable to compensate for the postural impairment of the paretic limb. Conclusions-The weight bearing asymmetry of standing stroke patients is not the primary cause of their postural imbalance, which is rather the consequence of impaired control of postural stabilization involving both limbs. Weight bearing asymmetry may not be the principle target of rehabilitation programs aiming at restoring standing balance after stroke. Instead it is suggested that more account should be taken of the compensatory role of the strong limb. (Stroke.

Assessment of Balance in Patients with Stroke

“…Literatürde de bu bulguyu destekleyen, çal›flmalar bulunmaktad›r (33)(34)(35). ‹nmeli hastalarda ayakta durma postürü sa¤lam ekstremiteye daha fazla a¤›rl›k verildi¤i asimetrik bir yük da¤›l›m› ile karakterizedir (36).…”

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke

“…Regarding the former, individuals with stroke generally stand asymmetrically, with more weight on the non-paretic than the paretic limb. 10 Given that the stance limb is pre-loaded, an APA may not be necessary to shift the patient's COM toward the stance limb when initiating gait with the paretic limb. Patchay and Gahéry 11 found that asymmetrical loading affected COP patterns prior to gait initiation in healthy adults, such that increased loading on the stance limb resulted in a reduced ML COP shift prior to gait initiation.…”

Comparação entre medidas de descarga, simetria e transferência de peso em indivíduos com e sem hemiparesia

“…Descarregar e transferir peso entre os hemicorpos é habilidade útil no processo de reabilitação de sujeitos vítimas de acidente vascular encefálico que adquirem hemiparesias [1][2][3][4][5][6][7] . Comumente, em hemiparéticos, a postura em pé é caracterizada por descarga de peso assimetricamente distribuída entre os hemicorpos 1,[3][4][5][6][8][9][10][11][12][13][14] .…”

“…Comumente, em hemiparéticos, a postura em pé é caracterizada por descarga de peso assimetricamente distribuída entre os hemicorpos 1,[3][4][5][6][8][9][10][11][12][13][14] . Apesar de tais sujeitos preferencialmente adotarem um padrão de assimetria que sobrecarrega o lado não afetado, na síndrome de Pusher observa-se postura assimétrica que sobrecarrega o lado afetado 15,16 .…”