Impaired Motor Function in the Affected Arm Predicts Impaired Postural Balance After Stroke: A Cross Sectional Study

Abstract

Background: Impaired postural balance is a common symptom after stroke and a common cause of falling. Most common daily tasks use arm and hand movements. Impairment in an upper extremity is a common stroke symptom, affecting 50–80% in the acute phase after stroke, and 40–50% in the sub-acute phase. The impact of leg function on postural balance has been investigated in several studies, but few have stressed the importance of arm function on postural balance. Objective: To explore whether there is any association between arm function and postural balance after stroke. Method: A cross sectional study where 121 adults (mean age: 70 ± 12.3 years, 72 men) from two different data sources, Gothenburg Very Early Supported Discharge (GOTVED), and a study by Carvalho et al. were merged. Time for assessments ranged from 1 to 13 years when the patients were in the chronic phase. The dependent variables were Berg Balance scale (BBS) and Time Up and Go (TUG) both dichotomized to “impaired postural balance” and “not impaired postural balance.” As independent variables, the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scale was used. The FMA-UE was presented with the total score. Results: The motor function in the arm affected after stroke onset correlated with postural balance both measured with the BBS (0.321, p < 0.001 ) and the TUG (−0.315, p = 0.001 ) . Having impaired motor function in the arm was significantly associated with impaired postural balance assessed with the BBS with OR = 0.879 (CI 0.826–0.934, p < 0.001). Regression analysis with the TUG showed the same result, OR = 0.868 (CI 0.813–0.927, p < 0.001) for FM-UE. Conclusion: The motor function of the affected arm was significantly associated with impaired postural balance post stroke, as assessed by BBS or TUG. It could be of clinical importance to be aware of the fact that not only lower extremity impairment, but also arm function can have an impact on postural balance in a late stage after stroke. Trial Registration: VGFOUGSB-669501.

A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health

“…The present study also observed association between other pairs among variables of structural impairments, activity limitations, participation restrictions, and contextual factors; for example, MAS and risk behavior, FMA-UE and SIS-P, FMA-UE and TUG, FMA-LE and BBS, APS and FES, SIS-P and BI. The association between FMA-either UE or LE and BBS as well as TUG was reported in individuals with stroke [13]. However, in the present study the correlation was out of the established importance boundary.…”

“…of upper and lower extremity in individuals with chronic stroke [59]. A study exploring association between arm function and postural balance suggested to concern not only lower limb but also the upper influencing on postural balance [13]. With the significant relationship establishing in the method and the evidence-based information it is definite to combine FMA-UE and FMA-LE to become a single variable for the next step of analysis.…”

“…Besides describing in the first order measurement model, the MAS, FMA-M, FMA-S, and APS explained falls at home in the structural model, but illustrating through activity limitations. In individuals with stroke, structural impairments such as increased muscle tone [6,7], impaired upper and lower limbs functions [13,[73][74][75], decreased sensory functions [74], and reduced APS [76] are risk for falling. The indirect effect of structural impairments may rationalize that in individuals with stroke muscle tone, motor and sensation functions, and APS alone could not affect falls at home.…”

“…Cause of falls is an interaction of various risk factors. Individuals with stroke contain a number of fall risk factors that can reciprocally link, for instance, lower limb performance and mobility [12], motor function and balance [13], balance and walking and participation restrictions [14], self-efficacy and physical activity [15], or environment and frequency of walking [16]. The International Classification of Functioning, Disability and Health (ICF) is a framework integrating medical and social components to describe health condition of people [17] and can be a possible framework for establishing and guiding management for patients [18,19].…”

Investigating the relation between upper extremity function and trunk control, balance and functional mobility in individuals with stroke

“…When the literature was reviewed, many studies (8,9) evaluating trunk control, balance, and lower extremity motor functions were detected; however, fewer studies were seen examining the effect of upper extremity functions on postural control and balance (10). As a matter of fact, decreased arm oscillations as a result of upper extremity problems affect postural balance negatively, and increase the risk of falls (11).…”