The investigation of stance symmetry, standing balance and physical mobility in patients with acute hemiplegic stroke

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The investigation of stance symmetry, standing balance and physical mobility in patients with acute hemiplegic stroke

 

Author: Chau, Mei-wa Rosanna
Title: The investigation of stance symmetry, standing balance and physical mobility in patients with acute hemiplegic stroke
Degree: M.Sc.
Year: 2000
Subject: Cerebrovascular disease -- Patients
Gait disorders
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xi, 96 leaves : ill. (chiefly col.) ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1541802
URI: http://theses.lib.polyu.edu.hk/handle/200/4638
Abstract: Introduction: Asymmetry in weight bearing and impaired dynamic balance are thought to contribute to the locomotion deficit in stroke. Previous studies showed that there was a greater proportion of body weight taken on the non-paretic than paretic limb. Some of the common stroke treatment approaches stressed on facilitation of weight bearing and transfer towards the paretic limb to improve movement quality and function. The rationale for its use was often anecdotal or based on balance researches performed at earlier days. This study was designed to investigate the stance symmetry and its relationship with standing balance and physical mobility in patients with acute hemiplegic stroke. Method: Thirteen patients with acute stroke (onset between day five to fourteen), having motor deficit over the right side of body were recruited through convenient sampling, to act as the study group. Thirteen age-, gender-, weight- and height- matched healthy elderly individuals participated as the control group. A Chattanooga Balance System was used to quantify the stance symmetry and balance performance. Functional Independence Measure was employed to measure the transfer and locomotion ability level. Results: No significant difference was found between healthy subjects and subjects with acute stroke for the stance symmetry (p=0.493 to 0.661). There was a significantly smaller medial-lateral maximal voluntary excursion of the center of pressure in the patient group when compared with control group (p=0.006). For the Linear Translation Test of the response to anterior-posterior perturbation, there was a bigger instability in both anterior-posterior and medial-lateral directions with significant difference shown in the medial-lateral direction (p=0.013). Stance symmetry was not related to transfer and locomotion ability level. Discussion: In contrast to previous findings, this study could not detect a stance asymmetry in patients with acute stroke, this could be related to the high function of these patients. Most of them could walk with some assistance. However, the voluntary control the center of pressure and the automatic response to perturbation in the patient group were worse than the control subjects, with significant difference revealed in the medial-lateral direction. Possible reasons for the instability could be the more demanding feature of the balance test on muscular strength, pattern synchronization in timing and scaling as well as inter-limbs coordination feature of the balance test compared with static stance test. Training programme in the restoration of stability in this direction was recommended even in the ambulatory patient without detectable stance asymmetry. Further study on patients with left and right hemiplegic stroke and in more dependent patients as well as investigation of muscular strengthen was warranted to further understanding on the association among symmetry, balance and function.

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