Is weight-bearing asymmetry associated with postural instability after stroke? A systematic review

Jip F Kamphuis, Digna de Kam, Alexander C H Geurts, Vivian Weerdesteyn, Jip F Kamphuis, Digna de Kam, Alexander C H Geurts, Vivian Weerdesteyn

Abstract

Introduction. Improvement of postural stability is an important goal during poststroke rehabilitation. Since weight-bearing asymmetry (WBA) towards the nonparetic leg is common, training of weight-bearing symmetry has been a major focus in post-stroke balance rehabilitation. It is assumed that restoration of a more symmetrical weight distribution is associated with improved postural stability. Objective. To determine to what extent WBA is associated with postural instability in people after stroke. Methods. Electronic databases were searched (Cochrane, MEDLINE, EMBASE, and CINAHL) until March 2012. Main Eligibility Criteria. (1) Participants were people after stroke. (2) The association between WBA and postural stability was reported. Quality of reporting was assessed with the STROBE checklist and a related tool for reporting of confounding. Results. Nine observational studies met all criteria. Greater spontaneous WBA was associated with higher center of pressure (COP) velocity and with poorer synchronization of COP trajectories between the legs (two and one studies, resp.). Evidence for associations between WBA and performance on clinical balance tests or falls was weak. Conclusion. Greater WBA after stroke was associated with increased postural sway, but the current literature does not provide evidence for a causal relationship. Further studies should investigate whether reducing WBA would improve postural stability.

Figures

Figure 1
Figure 1
Flow chart of systematic review of weight-bearing asymmetry (WBA) related to postural control.

References

    1. Kollen B, Kwakkel G, Lindeman E. Functional recovery after stroke: a review of current developments in stroke rehabilitation research. Reviews on Recent Clinical Trials. 2006;1(1):75–80.
    1. van de Port IG, Kwakkel G, Schepers VP, Lindeman E. Predicting mobility outcome one year after stroke: A Prospective Cohort Study. Journal of Rehabilitation Medicine. 2006;38(4):218–223.
    1. Kollen BJ, Kwakkel G, Lindeman E. Longitudinal robustness of variables predicting independent gait following severe middle cerebral artery stroke: A Prospective Cohort Study. Clinical Rehabilitation. 2006;20(3):262–268.
    1. Weerdesteyn V, de Niet M, van Duijnhoven HJR, Geurts ACH. Falls in individuals with stroke. Journal of Rehabilitation Research & Development. 2008;45(8):1195–1213.
    1. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2006;87(12):1583–1589.
    1. Aruin AS, Hanke T, Chaudhuri G, Harvey R, Noel R. Compelled weightbearing in persons with hemiparesis following stroke: the effect of a lift insert and goal-directed balance exercise. Journal of Rehabilitation Research and Development. 2000;37(1):65–72.
    1. Mizrahi J, Solzi P, Ring H, Nisell R. Postural stability in stroke patients: vectorial expression of asymmetry, sway activity and relative sequence of reactive forces. Medical and Biological Engineering and Computing. 1989;27(2):181–190.
    1. Sackley CM. Falls, sway, and symmetry of weight-bearing after stroke. International Disability Studies. 1991;13(1):1–4.
    1. Barra J, Oujamaa L, Chauvineau V, Rougier P, Pérennou D. Asymmetric standing posture after stroke is related to a biased egocentric coordinate system. Neurology. 2009;72(18):1582–1587.
    1. Mansfield A, Danells CJ, Inness E, Mochizuki G, McIlroy WE. Between-limb synchronization for control of standing balance in individuals with stroke. Clinical Biomechanics. 2011;26(3):312–317.
    1. De Haart M, Geurts AC, Huidekoper SC, Fasotti L, Van Limbeek J. Recovery of standing balance in postacute stroke patients: A Rehabilitation Cohort Study. Archives of Physical Medicine and Rehabilitation. 2004;85(6):886–895.
    1. Kollen BJ, Lennon S, Lyons B, et al. The effectiveness of the bobath concept in stroke rehabilitation what is the evidence? Stroke. 2009;40(4):e89–e97.
    1. Davies P. Steps to Follow: The Comprehensive Treatment of Patients with Hemiplegia. 2nd edition. Springer; 2000.
    1. Chaudhuri S, Aruin AS. The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis. Archives of Physical Medicine and Rehabilitation. 2000;81(11):1498–1503.
    1. Chen CH, Lin KH, Lu TW, et al. Immediate effect of lateral-wedged insole on stance and ambulation after stroke. American Journal of Physical Medicine and Rehabilitation. 2010;89(1):48–55.
    1. Dault MC, de Haart M, Geurts ACH, Arts IMP, Nienhuis B. Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients. Human Movement Science. 2003;22(3):221–236.
    1. Van Peppen RPS, Kortsmit M, Lindeman E, Kwakkel G. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. Journal of Rehabilitation Medicine. 2006;38(1):3–9.
    1. Pollock AS, Durward BR, Rowe PJ, et al. What is balance? Clinical Rehabilitation. 2000;14(4):402–406.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal. 2009;339(7716):332–336.
    1. Sanderson S, Tatt ID, Higgins JPT. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. International Journal of Epidemiology. 2007;36(3):666–676.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. 2007;370(9596):1453–1457.
    1. Vandenbroucke JP, Von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18(6):805–835.
    1. Groenwold RHH, Van Deursen AMM, Hoes AW, Hak E. Poor Quality of Reporting Confounding Bias in Observational Intervention Studies: a systematic review. Annals of Epidemiology. 2008;18(10):746–751.
    1. Roerdink M, Geurts ACH, De Haart M, Beek PJ. On the relative contribution of the paretic leg to the control of posture after stroke. Neurorehabilitation and Neural Repair. 2009;23(3):267–274.
    1. Marigold DS, Eng JJ. The relationship of asymmetric weight-bearing with postural sway and visual reliance in stroke. Gait and Posture. 2006;23(2):249–255.
    1. Marigold DS, Eng JJ, Timothy IJ. Modulation of ankle muscle postural reflexes in stroke: influence of weight-bearing load. Clinical Neurophysiology. 2004;115(12):2789–2797.
    1. Pereira LC, Botelho AC, Martins EF. Relationships between body symmetry during weight-bearing and functional reach among chronic hemiparetic patients. Revista Brasileira de Fisioterapia. 2010;14(3):259–266.
    1. Peurala SH, Könönen P, Pitkänen K, Sivenius J, Tarkka IM. Postural instability in patients with chronic stroke. Restorative Neurology and Neuroscience. 2007;25(2):101–108.
    1. van Asseldonk EHF, Buurke JH, Bloem BR, et al. Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients. Experimental Neurology. 2006;201(2):441–451.
    1. Mansfield A, Mochizuki G, Inness EL, McIlroy WE. Clinical correlates of between-limb synchronization of standing balance control and falls during inpatient stroke rehabilitation. Neurorehabilitation and Neural Repair. 2012;26(6):627–635.
    1. Geurts ACH, Nienhuis B, Mulder TW. Intrasubject variability of selected force-platform parameters in the quantification of postural control. Archives of Physical Medicine and Rehabilitation. 1993;74(11):1144–1150.
    1. Lafond D, Corriveau H, Hébert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Archives of Physical Medicine and Rehabilitation. 2004;85(6):896–901.
    1. Anker LC, Weerdesteyn V, van Nes IJW, Nienhuis B, Straatman H, Geurts ACH. The relation between postural stability and weight distribution in healthy subjects. Gait and Posture. 2008;27(3):471–477.
    1. Pérennou D. Postural disorders and spatial neglect in stroke patients: a strong association. Restorative Neurology and Neuroscience. 2006;24(4-6):319–334.
    1. Mansfield A, Inness EL, Lakhani B, McIlroy WE. Determinants of limb preference for initiating compensatory stepping poststroke. Archives of Physical Medicine and Rehabilitation. 2012;93(7):1179–1184.
    1. Genthon N, Gissot AS, Froger J, Rougier P, Pérennou D. Posturography in patients with stroke: estimating the percentage of body weight on each foot from a single force platform. Stroke. 2008;39(2):489–491.
    1. Genthon N, Rougier P, Gissot AS, Féroger J, Pélissier J, Pérennou D. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008;39(6):1793–1799.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner