JoVE Logo
Faculty Resource Center

Sign In

Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Behavior

Quantitative Static and Dynamic Assessment of Balance Control in Stroke Patients

Published: May 17th, 2020

DOI:

10.3791/60884

1Department of Rehabilitation, The Fifth Affiliated Hospital of Guangzhou Medical University, 2The Rehabilitation Medicine Lab of Guangzhou Medical University, 3Experiment Education Model Center of Rehabilitation Medicine, Guangzhou Medical University, 4Department of Rehabilitation Therapy, Guangzhou Medical University, 5College of Physical Education and Sports, Beijing Normal University, 6Department of Rehabilitation, Nanfang Hospital, Southern Medical University
* These authors contributed equally

Presented here is a quantitative, clinical balance assessment method suitable for stroke patients with balance disorders.

In patients with stroke, damage to the central nervous system (CNS) can affect the postural stability and increase the risk of falling. Therefore, accurately assessing the balance is important to understand the type, extent, and causes of balance deficit, and to identify individualized interventions. Clinical assessment methods for balance function can be broadly divided into observation, scale assessment, and balance instrument testing. Here, a clinical protocol is presented for static and dynamic balance assessment in stroke patients, which includes three semiquantitative balance function scale assessments (i.e., Berg Balance Scale, Timed Up and Go Test, and Fugl-Meyer Assessment) and three quantitative instrumental balance evaluation (i.e., Stability Assessment Module, Proprioceptive Assessment Module, and Limit of Stability Module). It is recommended that clinicians consider the use of both classic clinical balance scales and instrumental balance measurements when assessing stroke patients to improve the accuracy of assessments, leading to a better individualized treatment plan.

The human body can maintain posture stability under various conditions, including internal and external disturbances1. Balance relies on sensory input, integration of the central nervous system (CNS), and motor control2. In patients with stroke, damage to the CNS can affect the ability to maintain balance3. Postural instability is an important risk factor for falls4. Approximately 70% of patients experience a fall in the first year after stroke, often with serious consequences, such as hip fracture in elderly patients5,6<....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

The clinical project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University and has been registered at the China Clinical Trial Registration Center (No. ChiCTR1900021291) with the title “The mechanism and effect of Pro-kin system training on static and dynamic balance”.

1. Participant recruitment

  1. Include patients with brain hemorrhage or infarction confirmed by magnetic resonance imaging (MRI) or computerized tomo.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

Results from nine stroke patients with balance deficits are shown. The average age of the nine patients recruited in our study was 52.7 years; all of them were male. Four suffered from right hemiplegia. The average FIM-LE, TUG, and BBS values were 23.9 points, 31.8 s, and 46.8 points, respectively. The other demographic characteristics (BMI, stroke type, and onset time) are shown in Table 2. Each item score and the total scores of the BBS assessment of each of the nine stroke patients are shown in

Log in or to access full content. Learn more about your institution’s access to JoVE content here

Described is a clinical protocol for static and dynamic balance assessment in stroke patients that includes three semiquantitative balance function scale assessments (BBS, TUG, and FMA-LE) and three models of quantitative instrumental balance evaluation (Stability Assessment, Proprioceptive Assessment, and Limit of Stability). The design of this protocol was based on five main points.

First, the BBS is a 14-function-task on a 5-point scale that semiquantitatively assesses static and dynamic ba.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

The author thanks graduate student Zhencheng Guan, Wude Chen, Haidong Huang, and Qinyi Li (Guangzhou Medical University) for data collection. This study was supported by the National Natural Science Foundation for Young Scientists of China (Grant No.81902281); General Guidance Project of Guangzhou Health and Family Planning Commission (Grant No.20191A011091 and
No.20201A011108); Science and Technology Innovation Project for College Students in Guangzhou Medical University (Grant No. 2018A053), Guangzhou Key Laboratory Fund (Grant No.201905010004) and Major Industrial Technology Project of Guangzhou Science and Technology Bureau (Grant No.201902020001).

....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

NameCompanyCatalog NumberComments
Electric Lifting BedGuangzhou Yikang Medical Equipment Industrial Co., LtdYK-8000Required for Fugl-Meyer assessment
Percussion hammerICARE-MEDICAL Co., Ltd.CRT-104Required for Fugl-Meyer assessment
Prokin Balance SystemTecnobody .S.r.l, ItalyProKin 252Balance evaluation and training system
RulerM&G Chenguang Stationery Co.,Ltd.AHT99112Required for Berg Balance Scale assessment
Stopwatch95,Shenzhen Junsd Industrial Co., Ltd have been striven all the years deJS-306Required for Berg Balance Scale assessment

  1. Jonsson, E., Henriksson, M., Hirschfeld, H. J. Age-related differences in postural adjustments in connection with different tasks involving weight transfer while standing. Gait Posture. 26 (4), 508-515 (2007).
  2. Rasman, B. G., Forbes, P. A., Tisserand, R., Blouin, J. S. Sensorimotor Manipulations of the Balance Control Loop-Beyond Imposed External Perturbations. Frontiers in Neurology. 9, 899 (2018).
  3. Koch, G., et al. Effect of Cerebellar Stimulation on Gait and Balance Recovery in Patients With Hemiparetic Stroke: A Randomized Clinical Trial. JAMA Neurology. 76 (2), 170-178 (2019).
  4. Kam, D. D., Roelofs, J. M. B., Bruijnes, A. K. B. D., Geurts, A. C. H., Weerdesteyn, V. J. N. N. R. The Next Step in Understanding Impaired Reactive Balance Control in People With Stroke: The Role of Defective Early Automatic Postural Responses. Neurorehabilitation and Neural Repair. 31 (8), 708-716 (2017).
  5. Forster, A., Young, J. Incidence and consequences of falls due to stroke: a systematic inquiry. British Medical Journal. 311 (6997), 83-86 (1995).
  6. Geurts, A. C. H., Mirjam, D. H., Nes, I. J. W., Van Jaak, D. A review of standing balance recovery from stroke. Gait, Posture. 22 (3), 267-281 (2005).
  7. Mehdizadeh, H., et al. Effects of cognitive load on the amount and temporal structure of postural sway variability in stroke survivors. Experimental Brain Research. 236 (1), 285-296 (2018).
  8. Cho, K., Lee, K., Lee, B., Lee, H., Lee, W. Relationship between Postural Sway and Dynamic Balance in Stroke Patients. The Journal of Physical Therapy Sciences. 26 (12), 1989-1992 (2014).
  9. Blum, L., Korner-Bitensky, N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Physical Therapy. 88 (5), 559-566 (2008).
  10. Brynskov, J., Thyssen, H., Jansen, E., Munster-Swendsen, J. Cimetidine and Romberg's test. Lancet. 1 (8183), 1421 (1980).
  11. Tinetti, M. E. Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society. 34 (2), 119-126 (1986).
  12. Berg, K. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 41 (6), 304-311 (1989).
  13. Fugl-Meyer, A. R., Jaasko, L., Leyman, I., Olsson, S., Steglind, S. The poststroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine. 7 (1), 13-31 (1975).
  14. Basford, J. R., et al. An assessment of gait and balance deficits after traumatic brain injury. Archiives of Physical Medicine and Rehabilitation. 84 (3), 343-349 (2003).
  15. Meiners, K. M., Loudon, J. K. Dynamic and Static Assessment of Single-Leg Postural Control in Female Soccer Players. Journal of Sport Rehabilitation. 29 (2), 1-5 (2019).
  16. Toprak Celenay, S., Mete, O., Coban, O., Oskay, D., Erten, S. Trunk position sense, postural stability, and spine posture in fibromyalgia. Rheumatology International. 39 (12), 2087-2094 (2019).
  17. Haliloglu, O., et al. Static and dynamic balances of patients with acromegaly and impact of exercise on balance. Pituitary. 22 (5), 497-506 (2019).
  18. Zhang, J., et al. Higher Adiposity Is Associated With Slower Cognitive Decline in Hypertensive Patients: Secondary Analysis of the China Stroke Primary Prevention Trial. Journal of the American Heart Association. 6 (10), 005561 (2017).
  19. Shumway-Cook, A., Baldwin, M., Polissar, N. L., Gruber, W. Predicting the probability for falls in community-dwelling older adults. Physical Therapy. 77 (8), 812-819 (1997).
  20. Liang, J., et al. The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation. Journal of Visualized Experiments. (149), e59829 (2019).
  21. Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., Maki, B. Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health. 83, 7-11 (1992).
  22. Liston, R. A., Brouwer, B. J. Reliability and validity of measures obtained from stroke patients using the Balance Master. Archives of Physical Medicine and Rehabilitation. 77 (5), 425-430 (1996).
  23. Mao, H. F., Hsueh, I. P., Tang, P. F., Sheu, C. F., Hsieh, C. L. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 33 (4), 1022-1027 (2002).
  24. Chou, C. Y., et al. Developing a short form of the Berg Balance Scale for people with stroke. Physical Therapy. 86 (2), 195-204 (2006).
  25. Wernick-Robinson, M., Krebs, D. E., Giorgetti, M. M. Functional reach: Does it really measure dynamic balance. Archives of Physical Medicine and Rehabilitation. 80 (3), 262-269 (1999).
  26. Pickerill, M. L., Harter, R. A. Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices. Journal of Athletic Training. 46 (6), 600-606 (2011).
  27. Clark, S., Rose, D. J. Evaluation of dynamic balance among community-dwelling older adult fallers: A generalizability study of the limits of stability test. Archives of Physical Medicine and Rehabililation. 82 (4), 468-474 (2001).
  28. Ikai, T., Kamikubo, T. I., Nishi, M., Miyano, S. Dynamic postural control in patients with hemiparesis. American Journal of Physical Medicine, Rehabilitation. 82 (6), 484 (2003).
  29. Brown, L. A., Sleik, R. J., Winder, T. R. Attentional demands for static postural control after stroke. Archives of Physical Medicine and Rehabilitation. 83 (12), 1732-1735 (2002).
  30. Kyoungsim, J., Young, K., Yijung, C., Sujin, H. J. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. Tokyo Journal of Experimental Medicine. 232 (3), 195-199 (2014).
  31. Mancini, M., Horak, F. B. The relevance of clinical balance assessment tools to differentiate balance deficits. European Journal of Physical and Rehabilitation Medicine. 46 (2), 239-248 (2010).
  32. Downs, S., Marquez, J., Chiarelli, P. Normative scores on the Berg Balance Scale decline after age 70 years in healthy community-dwelling people: a systematic review. Journal of Physiotherapy. 60 (2), 85-89 (2014).

This article has been published

Video Coming Soon

JoVE Logo

Privacy

Terms of Use

Policies

Research

Education

ABOUT JoVE

Copyright © 2024 MyJoVE Corporation. All rights reserved