Relationship between asymmetry of quiet standing balance control and walking post-stroke

Abstract

Spatial and temporal gait asymmetry is common after stroke. Such asymmetric gait is inefficient, can contribute to instability and may lead to musculoskeletal injury. However, understanding of the determinants of such gait asymmetry remains incomplete. The current study is focused on revealing if there is a link between asymmetry during the control of standing balance and asymmetry during walking. This study involved review of data from 94 individuals with stroke referred to a gait and balance clinic. Participants completed three tests: (1) walking at their usual pace; (2) quiet standing; and (3) standing with maximal loading of the paretic side. A pressure sensitive mat recorded placement and timing of each footfall during walking. Standing tests were completed on two force plates to evaluate symmetry of weight bearing and contribution of each limb to balance control. Multiple regression was conducted to determine the relationships between symmetry during standing and swing time, stance time, and step length symmetry during walking. Symmetry of antero-posterior balance control and weight bearing were related to swing time and step length symmetry during walking. Weight-bearing symmetry, weight-bearing capacity, and symmetry of antero-posterior balance control were related to stance time symmetry. These associations were independent of underlying lower limb impairment. The results support the hypothesis that impaired ability of the paretic limb to control balance may contribute to gait asymmetry post-stroke. Such work suggests that rehabilitation strategies that increase the contribution of the paretic limb to standing balance control may increase symmetry of walking post-stroke.

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

“…Regression analyses were conducted to quantify relationships between balance confidence and the outcome measures [11], using multiple linear regression [22] for the continuous outcome measures and binary logistic regression [12] for the binary outcome measures. Only individuals who completed each assessment were included in the analysis for that assessment.…”

“…The feet were positioned with one foot on each of two adjacent force plates (Advanced Mechanical Technology, Inc., Watertown, MA), according to a standardized template [21]. Ground reaction forces and moments were sampled at 256 Hz, and low-pass filtered using a dual-pass, fourth-order Butterworth filter (cutoff frequency: 10 Hz [22]). Net and individual-limb COP signals were calculated for both the antero-posterior and medio-lateral directions.…”

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

“…28 This delay may also translate to slowed steadystate walking. Hesitation when loading the paretic leg may partially explain slow walking speeds 29 and temporal asymmetry 30,31 among those with post-stroke motor impairment. However, it is important to acknowledge that only the ML COP was used in the identification of APAs and associated characteristics in the present study.…”

Cross-cultural adaptation to Brazilian Portuguese of the Waterloo Footedness Questionnaire-Revised: WFQ-R-Brazil

“…Although recent studies 9,11,12,13 point to the relationship between sensory deficits and asymmetry in the weight-bearing distribution during upright stance, more robust evidence must be attained.…”

“…According to the relationship between the severity of post-stroke motor deficits and the weight-bearing distribution, some evidence indicates that individuals with more severe hemiparesis tend to adopt a more asymmetric strategy when compared to those with mild hemiparesis 6,9,11,13 . In this regard, Mundim et al 7 have hypothesized that the lower limb predominantly used for support during an upright stance is established by preference for post-stroke hemiparesis patients presenting with mild to moderate hemiparesis, or by convenience in the patients with moderate to severe hemiparesis.…”