Determinants of Balance Recovery After Stroke - Retrospective Study (DOBRAS-R)

Determinants of Balance Recovery After Stroke

Retrospective cohort study of consecutive patients investigated in a neurorehabilitation ward after a first hemispheric stroke. Postural and gait disorders in relation to referential of verticality have been analyzed in routine care.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Postural Assessment Scale for Stroke (PASS)

Detailed Description

300 consecutive patients, admitted in our department for neurorehabilitation after a first hemispherical stroke, have been enrolled retrospectively. During their hospitalisation, all patients have been routinely evaluated with clinical scales, evaluating motor and cognitive deficits. Postural and visual vertical (VV) assessments have been performed 1 to 4 times during in-patient-stay.

The objective was to analyse the determinants of balance recovery after stroke, in particular the impact of wrong referential of verticality.

Data collection was performed by means of medical records. Observation period covered from january 2012 to february 2018.

• Study Type: Observational
• Enrollment (Actual): 300

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

consecutive patients admitted in neurorehabilitation ward after first hemispheric stroke

Description

Inclusion Criteria:

first hemispheric stroke patient non-opposed to inclusion

Exclusion Criteria:

history of neurological disorders interfering with balance history of vestibularly disorders interfering with balance unstable medical conditions history of cognitive disorders

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Posture	Change from Baseline Score of Postural Assessment Scale for Stroke (PASS) at discharge	admission and monthly, up to 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance	Assessment of Balance and Posture with SCP (Scale for Contraversive Pushing)	admission and monthly, up to 3 months
Gait	Assessment of Gait with Lindmark test	admission and monthly, up to 3 months
Postural disorders	Assessment of Postural control with CDP (Computerized posturography)	admission and monthly, up to 3 months
Visual vertical perception	Assessment of the visual vertical (vv). Subject indicates which direction a visual line displayed on a computer screen (in darkness) is perceived as vertical in the roll plane.	admission and monthly, up to 3 months
Postural vertical perception	Assessment of the postural vertical (pv). Subject is seated in a specific device (CE-marked) in darkness, and indicates which direction of her/his whole body is perceived as vertical in the roll plane.	admission and monthly, up to 3 months
Walking distance	Assessment of walking distance with the 6-minute-walking-test (6-MWT)	admission and monthly, up to 3 months
Gait velocity	Assessment of gait velocity at self-prefered-velocity on 10 meters	admission and monthly, up to 3 months
Pressure sensitivity (Hand and foot)	Assessment of hypoesthesia with Semmes-Weinstein monofilaments test	admission and monthly, up to 3 months
Spasticity	Assessment of Spasticity with Ashworth Scale	admission and monthly, up to 3 months
Laterality	Assessment of Laterality with Edinburgh Handedness Inventory	admission and monthly, up to 3 months
Disability	Assessment of Autonomy with FIM (Functional Independence Measure)	admission and monthly, up to 3 months
Neuropsychological Assessment 1	Assessment of Hemispatial Neglect with the Catherine Bergego Scale (CBS)	admission and monthly, up to 3 months
Neuropsychological Assessment 2	Assessment of Hemispatial Neglect with the fluff Test	admission and monthly, up to 3 months
Neuropsychological Assessment 3	Assessment of Hemispatial Neglect using 'thumb localizing test' (TLT)	admission and monthly, up to 3 months
Neuropsychological Assessment 4	Assessment of Hemispatial Neglect with the 'Comb and Razor Test'	admission and monthly, up to 3 months
Neuropsychological Assessment 5	Assessment of Hemispatial Neglect with the BEN ( Battery of tests for the quantitative assessment of unilateral neglect)	admission and monthly, up to 3 months
Neuropsychological Assessment 6	Assessment of Apraxia with ATS (Apraxia Screen of TULIA)	admission and monthly, up to 3 months
Neuropsychological Assessment 7	Assessment of Language with LAST (Language Screening Test)	admission and monthly, up to 3 months
Neuropsychological Assessment 8	Assessment of Aphasia with BDAE (Boston Diagnostic Aphasia Examination)	admission and monthly, up to 3 months
Neuropsychological Assessment 10	Assessment of depression with ADRS (Aphasia Depression Rating Scale)	admission and monthly, up to 3 months
Falls	Monitoring of falls occuring during the hospitalization	at discharge, the number of falls is totalized
Visual field defect (hemianopia/quadranopia)	standardized clinical examination	admission and monthly, up to 3 months
Identification of brain structures involved in the stroke	anatomical MRI	once, at 2 month

Collaborators and Investigators

• Sponsor: University Hospital, Grenoble

Publications and helpful links

General Publications

• Pérennou D, Chauvin A, Piscicelli C, Hugues A, Dai S; Collaborators for the posturography study in the Determinants of Balance Recovery After Stroke (DOBRAS) cohort. Determining an optimal posturography dataset to identify standing behaviors in the post-stroke subacute phase. Cross-sectional study. Ann Phys Rehabil Med. 2022 Sep 28:101707. doi: 10.1016/j.rehab.2022.101707. [Epub ahead of print]
• Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Perennou D. Lateropulsion After Hemispheric Stroke: A Form of Spatial Neglect Involving Graviception. Neurology. 2021 Apr 27;96(17):e2160-e2171. doi: 10.1212/WNL.0000000000011826. Epub 2021 Mar 15.
• Dai S, Piscicelli C, Lemaire C, Christiaens A, Schotten MT, Hommel M, Krainik A, Detante O, Perennou D. Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study. Ann Phys Rehabil Med. 2022 Jan;65(1):101488. doi: 10.1016/j.rehab.2021.101488. Epub 2021 Nov 11.
• Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Perennou D. Balance, Lateropulsion, and Gait Disorders in Subacute Stroke. Neurology. 2021 Apr 27;96(17):e2147-e2159. doi: 10.1212/WNL.0000000000011152. Epub 2020 Nov 11.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2012
• Primary Completion (Actual): October 31, 2019
• Study Completion (Actual): October 31, 2019

Study Registration Dates

• First Submitted: May 2, 2017
• First Submitted That Met QC Criteria: June 28, 2017
• First Posted (Actual): June 29, 2017

Study Record Updates

• Last Update Posted (Actual): November 8, 2019
• Last Update Submitted That Met QC Criteria: November 7, 2019
• Last Verified: November 1, 2019

More Information

Terms related to this study

• Keywords: gait; balance; posture; PASS; lateropulsion; pusher syndrome; verticality perception
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: 38RC17.126

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No