Is the Recovery of Functional Balance and Mobility Accompanied by Physiological Recovery in People With Severe Impairments After Stroke?

Peters, Sue; Ivanova, Tanya D.; Teasell, Robert; Garland, S. Jayne

doi:10.1177/1545968314526644

Cited by 11 publications

(11 citation statements)

References 33 publications

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“…Changes in functional performance (eg, as measured by observational rating scales) can also improve despite little evidence of restoration of the paretic limb's contribution to balance control. 22,38 Therefore, we believe it is essential to differentiate between simple loading asymmetry and asymmetries in limb contribution to balance control to unmask dyscontrol underlying observed patient performance. This kind of specific information allows physiotherapists to determine what aspects of balance control change with intervention, and thus inform new intervention approaches.…”

Section: Discussionmentioning

confidence: 99%

Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation

Mansfield

Inness

2015

Rehabilitation Process and Outcome

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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, weightbearing 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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Section: Discussionmentioning

confidence: 99%

Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation

Mansfield

Inness

2015

Rehabilitation Process and Outcome

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“…17 Finally, some individuals post-stroke can improve their BBS scores without any concomitant improvement in physiological measures of standing balance. 18,19 Thus, individuals may achieve ''good'' BBS performance by applying compensatory strategies without recovering from the stroke-related impairments underlying their poor balance. 18 Thus, individuals who achieve a BBS score greater than the age-and gender-matched normal value may still not have normal balance.…”

mentioning

confidence: 99%

A Retrospective Analysis of Post-Stroke Berg Balance Scale Scores: How Should Normal and At-Risk Scores Be Interpreted?

Patterson

Inness

McIlroy

et al. 2017

Physiotherapy Canada

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Purpose: The Berg Balance Scale (BBS) is a performance-based measure of standing balance commonly used by clinicians working with individuals poststroke. Performance on the BBS can be influenced by compensatory strategies, but measures derived from two force plates can isolate compensatory strategies and thus better indicate balance impairment. This study examined BBS scores that reflect ''normal'' and disordered balance with respect to dual force-plate measures of standing balance in individuals post-stroke. Methods: BBS and force-plate measures were extracted from 75 patient charts. Individuals were classified by BBS score with respect to (1) age-matched normative values and (2) values that suggested increased risk of falls. Multiple analysis of variance was used to examine the effect of group assignment on force-plate measures of standing balance. Results: Individuals with BBS scores within and below normative values did not differ in force-plate measures. Individuals with BBS scores below the falls risk cutoff loaded their affected leg less than individuals with BBS scores above the cutoff. There were no other differences in force-plate measures between these two groups. Conclusions: BBS scores indicating either normal or disordered balance function are not necessarily associated with normal or disordered quiet standingbalance control measured by two force plates. This finding suggests that the BBS may reflect a capacity for compensation rather than any underlying impairments.Key Words: balance; Berg Balance Scale; force-plate measures; stroke. RÉ SUMÉObjectif : l'é chelle de Berg est un outil de mesure de l'é quilibre debout fré quemment utilisé par les cliniciens traitant des personnes ayant subi un AVC. Des straté gies compensatoires peuvent influencer le score Berg, mê me si les mesures obtenues de deux plateformes de force peuvent isoler les straté gies compensatoires et ainsi mieux dé tecter les troubles d'é quilibre. L'objectif de cette é tude é tait d'examiner les scores Berg indiquant un é quilibre « normal » et un trouble d'é quilibre parallè lement aux doubles mesures des plateformes de l'é quilibre debout de personnes ayant subi un AVC. Mé thodologie : on a extrait le score Berg et les mesures des plateformes de 75 dossiers mé dicaux de patients. On a classé les personnes selon leur score Berg en tenant compte (1) des valeurs normatives apparié es selon l'â ge et (2) des valeurs suggé rant un risque accru de chutes. On a ré alisé une analyse de variance multivarié e pour examiner l'effet de la ré partition des groupes sur les mesures de l'é quilibre debout obtenues à l'aide des plateformes. Ré sultats : les personnes ayant obtenu un score Berg é gal ou infé rieur aux valeurs normatives n'ont pas obtenu de mesures diffé rentes sur les plateformes. Les personnes ayant obtenu un score Berg sous le seuil de risque de chute mettaient moins de charge sur la jambe touché e que les personnes ayant obtenu un score Berg au-dessus du seuil. Il n'y avait aucune autre diffé rence dans les mesures des...

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“…As well, the outcomes of the review focused on not just physical function but immobility-related poststroke complications, which are known to be higher in the severe stroke population and contribute to high levels of caregiver burden 28–30. In terms of limitations, it has been reported that the defining severe stroke is difficult due to different criteria used to classify severity 79. The use of objective scores on validated outcome measures to classify stroke severity in our systematic review was deemed necessary to ensure that participants had actually sustained a severe stroke.…”

Section: Discussionmentioning

confidence: 99%

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

et al. 2020

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ObjectiveTo evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.DesignSystematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.Results28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.ConclusionsThere is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.PROSPERO registration numberCRD42017077737

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Is the Recovery of Functional Balance and Mobility Accompanied by Physiological Recovery in People With Severe Impairments After Stroke?

Cited by 11 publications

References 33 publications

Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation

Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation

A Retrospective Analysis of Post-Stroke Berg Balance Scale Scores: How Should Normal and At-Risk Scores Be Interpreted?

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

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