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van Dijk M.M.1, Wiskerke E.2, Thuwis R.2, Myny C.2, Vandekerckhove C.2, Dejaeger E.3, Beyens H.1, Verheyden G.2
1UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium, 2KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 3UZ Leuven - University Hospitals Leuven, Department of Geriatrics, Leuven, Belgium
Background: One of the key consequences of stroke in daily life is balance impairment, affecting both sitting and standing. Sitting balance and trunk control are strongly correlated with general mobility, execution of transfers, risk of falling and activities of daily living. Both are important predictors for the duration of hospital stay and motor and functional outcome. In clinical practise, standardized outcome measure are used to assess balance, while in research a force platform is frequently used. Force platforms offer a more objective way to assess the position and displacement of the centre of pressure (COP) during sway and voluntary weight transfers. In the stroke population they are mainly used for measurements in standing, while research in sitting, investigating participants with both a clinical and force platform measurement, is sparse.
Purpose: The aim of this cross-sectional observational study was to compare the maximum voluntary weight shift in sitting in the lateral and diagonal direction between patients with stroke and a healthy control group. Secondly, we related weight shift in patients with stroke, with clinical balance and trunk control measurements.
Methods: A total of 14 non-ambulatory patients with stroke in the subacute phase were recruited from the inpatient rehabilitation ward of the University Hospitals Leuven, Pellenberg, Belgium. The control group consisted of 32 healthy elderly, with no significant difference in age and gender between the patients with stroke and healthy elderly. A force-platform (BioRescue, RM Ingénierie, France) was used to measure the maximum voluntary weight shifts in sitting (COP distance). COP distance was collected towards the preferred side of support (PSOS) and the non-preferred side of support (NPSOS). The Berg Balance Scale (BBS) was used to assess balance, the Trunk Control Test (TCT), the Trunk Impairment Scale by Verheyden et al. (TIS-1) and the Trunk Impairment Scale by Fujiwara et al. (TIS-2) assessed trunk control.
Results: COP distance was significantly smaller for patients with stroke in all directions compared to the healthy controls (p 0.05). Correlations between COP distance and clinical measures were moderate to very high in all directions. For balance (BBS) a very high correlation was found in the medio-lateral direction towards the PSOS (r=.891) and in the diagonal forward direction towards the NPSOS (r=.804). The TIS-1 had a very high correlation with COP distance in the diagonal forward direction towards the PSOS and the NPSOS (r=.822 and r=.813, respectively).
Conclusion(s): Maximum voluntary weight shifts in non-ambulatory patients with stroke are smaller compared to controls. These weight shifts have a substantial correlation with clinical measures of balance and trunk control. Assessing balance in sitting with a force platform and maximum voluntary weight shifts provides an applicable representation of a patient´s dynamic balance ability.
Implications: Further research should focus not only on the clinically applicability of a force platform to assess balance, but also on the training aspect. Force platforms could provide an intensive, enjoyable and motivating treatment for balance deficits in sitting.
Funding acknowledgements: non
Topic: Neurology: stroke
Ethics approval: Medical Ethics Committee of the UZ Leuven - University Hospitals Leuven, Belgium
All authors, affiliations and abstracts have been published as submitted.
