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Cited by 447Stroke Rehabilitation and RecoveryBalance, Gait, and Falls PreventionDysphagia Assessment and Management

Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

de Haart, Mirjam, Geurts, Alexander C, Huidekoper, Steven C, Fasotti, Luciano, van Limbeek, Jacques·2004·Archives of Physical Medicine and Rehabilitation
DOI 10.1016/j.apmr.2003.05.012
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Abstract

Objective To identify and interrelate static and dynamic characteristics of the restoration of quiet standing balance in a representative sample of stroke survivors in the Netherlands during their inpatient rehabilitation.Design Exploratory study using an inception cohort with findings related to reference values from healthy elderly persons.Setting Rehabilitation center.Participants Thirty-seven inpatients (mean age, 61.6y; mean time poststroke, 10.0wk) with a first hemispheric intracerebral infarction or hematoma who were admitted to retrain standing balance and walking.Intervention Individualized therapy.Main outcome measures Center of pressure fluctuations were registered under each foot and in the sagittal and frontal planes separately by using a dual-plate force platform. The first balance measurements took place as soon as patients were able to stand unassisted for at least 30 seconds as well as 2, 4, 8, and, 12 weeks later. Quiet standing was assessed under 4 conditions: with and without a visual midline reference, with the eyes closed, and while performing a concurrent arithmetic task.Results The stroke patients showed excessive postural sway and instability, particularly in the frontal plane, compared with reference values. Frontal plane balance was, however, also most responsive to the effects of balance training and recovery (P<.001). The degree of visual dependency for frontal plane balance control showed a significant reduction in time (P<.02). Weight-bearing asymmetry, which was most pronounced in patients with disturbed sensibility or ankle clonus, diminished considerably during the first 4 weeks of the follow-up period (P<.02). Yet, a substantial degree of weight-bearing asymmetry persisted during the 8 weeks thereafter, and it continued to be aggravated by attentional distraction (P<.001). During the same period, static asymmetry (ie, the degree of pes equinovarus loading at the paretic side) and dynamic asymmetry (ie, the extent to which compensatory ankle moments are applied at the nonparetic side) did not show normalization at all, although motor selectivity of the paretic leg improved by 1 stage on the 6-stage Brunnstrom scale (P<.001) and the independency level of balance and walking skills improved by 2 points on the 6-point Functional Ambulation Categories (P<.001).Conclusions Balance recovery in postacute stroke inpatients is characterized by a reduction in postural sway and instability as well as by a reduction in visual dependency, particularly with regard to frontal plane balance. These restoration characteristics may be important factors underlying the relearning of independent standing and walking abilities. The clear lack of normalization for measures reflecting static and dynamic aspects of postural asymmetry suggests that the functional improvements in balance and gait must be more related to other mechanisms than to the restoration of support functions and equilibrium reactions of the paretic leg.

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  • The perceived relationship between symmetry in weight distribution while standing and walking and balance has not been proven.

    “Bobath therapists have assumed that a symmetrical weight distribution implies better postural control, but this perceived relationship between symmetry in weight distribution while standing and walking and balance has not been proven.56,[63][64][65]”

    From The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? (2009) · cites this paper as [63]

  • A reduction in postural sway and visual dependency while standing occurred without normalization of weight distribution toward the paretic leg.

    “de Haart et al showed that a reduction in postural sway and visual dependency while standing occurred without normalization of weight distribution toward the paretic leg.63,64”

    From The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? (2009) · cites this paper as [63]

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Authors
de Haart, M., Geurts, A. C., Huidekoper, S. C., Fasotti, L., & van Limbeek, J.
Affiliations
Sint Maartenskliniek (NL)
Corresponding author
Geurts, Alexander C
ORCID
Venue
Archives of Physical Medicine and Rehabilitation
Publisher
Elsevier BV
Published
2004-06
Volume
85
Issue
6
Pages
886-895
ISSN
0003-9993 (ISSN-L)
DOI
10.1016/j.apmr.2003.05.012
OpenAlex
W2160046250
Cited by
447
References
52
Citations by year
2026: 8 · 2025: 14 · 2024: 19 · 2023: 18 · 2022: 14 · 2021: 22 · 2020: 21 · 2019: 23 · 2018: 26 · 2017: 18 · 2016: 29 · 2015: 36 · 2014: 39 · 2013: 34 · 2012: 18
FWCI
11.31
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Archives of Physical Medicine and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
stroke rehabilitation, postural sway, center of pressure, weight-bearing asymmetry, postural control, visual dependency, attentional distraction, ankle clonus, pes equinovarus, Brunnstrom stages, post-stroke hemiparesis, inpatient rehabilitation, hemispheric infarction, force plate, gait training
MeSH terms
Stroke Rehabilitation, Adult, Aged, Aged, 80 and over, Postural Balance, Female, Humans, Male, Middle Aged, Posture, Proprioception, Psychomotor Performance, Reference Values, Task Performance and Analysis, Visual Perception, Cohort Studies, Weight-Bearing, Recovery of Function, Stroke

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