Correlations between measures of dynamic balance in individuals with post-stroke hemiparesis

Abstract

Mediolateral balance control during walking is a challenging task in post-stroke hemiparetic individuals. To detect and treat dynamic balance disorders, it is important to assess balance using reliable methods. The Berg Balance Scale (BBS), Dynamic Gait Index (DGI), margin-of-stability (MoS), and peak-to-peak range of angular-momentum (H) are some of the most commonly used measures to assess dynamic balance and fall risk in clinical and laboratory settings. However, it is not clear if these measures lead to similar conclusions. Thus, the purpose of this study was to assess dynamic balance in post-stroke hemiparetic individuals using BBS, DGI, MoS and the range of H and determine if these measure are correlated. BBS and DGI were collected from 19 individuals post-stroke. Additionally, kinematic and kinetic data were collected while the same individuals walked at their self-selected speed. MoS and the range of H were calculated in the mediolateral direction for each participant. Correlation analyses revealed moderate associations between all measures. Overall, a higher range of angular-momentum was associated with a higher MoS, wider step width and lower BBS and DGI scores, indicating poor balance control. Further, only the MoS from the paretic foot placement, but not the nonparetic foot, correlated with the other balance measures. Although moderate correlations existed between all the balance measures, these findings do not necessarily advocate the use of a single measure as each test may assess different constructs of dynamic balance. These findings have important implications for the use and interpretation of dynamic balance assessments.

Elderly Fallers Enhance Dynamic Stability Through Anticipatory Postural Adjustments during a Choice Stepping Reaction Time

“…The results pointing out that elderly F prioritize a more stable strategy than NF at FO could be interpreted as a poorer control of balance and an increased risk of fall. It has recently been suggested that an increased MoS is an indicator of a decreased control of lateral balance and a higher risk of fall during gait (Vistamehr et al, 2016). …”

Asymmetric Gait Patterns Alter the Reactive Control of Intersegmental Coordination Patterns during Walking

“…Angular momentum can also capture balance impairments in populations with gait asymmetries and sensorimotor deficits such as amputees and stroke survivors. These individuals often have a higher peak-to-peak range of angular momentum than healthy controls [13–16], and the presence of gait asymmetries may contribute to balance impairments in these populations. For example, the magnitude of step length asymmetry in people-post stroke is negatively correlated with scores on the Berg Balance Scale, indicating that step length asymmetry is associated with increased fall risk [17].…”

Sensorimotor Strategies in Individuals With Poststroke Hemiparesis When Standing Up Without Vision

“…Previous studies on dynamic balance control demonstrated that the paretic side had a weaker response to perturbations (de Kam, Kamphuis, Weerdesteyn, & Geurts, 2017), and that mediolateral gait instability was greater (Kao, Dingwell, Higginson, & Binder-Macleod, 2014) in poststroke people compared with healthy individuals. Other studies have investigated correlations between clinical scores and laboratory-based measures, including marginof-stability (Vistamehr, Kautz, Bowden, & Neptune, 2016) and whole-body angular momentum (Nott, Neptune, & Kautz, 2014), and examined the effect of visual feedback on gait in individuals with chronic stroke (Walker, Hyngstrom, & Schmit, 2016). However, it is unclear how individuals with hemiparesis adapt to accommodate both the major direction of motion (anteroposterior or vertical) and the mediolateral direction that is inherently unstable for them.…”