Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related?

Jonas Schröder; Wim Saeys; Elissa Embrechts; Ann Hallemans; Laetitia Yperzeele; Steven Truijen; Gert Kwakkel

doi:10.1177/15459683231186983

Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related?

Neurorehabil Neural Repair. 2023 Aug;37(8):530-544. doi: 10.1177/15459683231186983. Epub 2023 Aug 19.

Authors

Jonas Schröder¹, Wim Saeys^{1

2}, Elissa Embrechts¹, Ann Hallemans¹, Laetitia Yperzeele^{3

4}, Steven Truijen¹, Gert Kwakkel^{5

6

7}

Affiliations

¹ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium.
² Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium.
³ Neurovascular Center Antwerp and Stroke Unit, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.
⁴ Research Group on Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
⁵ Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
⁷ Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands.

PMID: 37596887
DOI: 10.1177/15459683231186983

Abstract

Background: Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements.

Objective: To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke.

Methods: Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COP_Area) and direction-dependent velocities (COP_Vel-ML and COP_Vel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry.

Results: Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COP_Area, COP_Vel-ML, and COP_Vel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COP_Area, COP_Vel-ML, and COP_Vel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COP_Area, COP_Vel-ML, COP_Vel-AP, DCA, or WBA were generally non-significant.

Conclusions: Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke.Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.

Keywords: longitudinal study; postural sway; posturography; recovery; standing balance; stroke.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Humans
Linear Models
Lower Extremity
Middle Aged
Motor Disorders*
Weight-Bearing

Associated data

ClinicalTrials.gov/NCT03728036