Abstract
Falls are a leading cause of serious injury and restricted participation among persons with stroke (PwS). Reactive balance control is essential for fall prevention, however, only a few studies have explored the effects of lesion characteristics (location and extent) on balance control in PwS. We aimed to assess the impact of lesion characteristics on reactive and anticipatory balance capacity, gait, and hemiparetic lower limb function, in PwS. Forty-six subacute PwS were exposed to forward, backward, right and left unannounced horizontal surface translations in six increasing intensities while standing. Fall threshold (i.e., perturbation intensity that results in a fall into the harness system) was measured. In addition, the Berg Balance Scale (BBS), 6 Minute Walk Test (6MWT) and Lower Extremity Fugl-Meyer (LEFM) were measured. Lesion effects were analyzed separately for left and right hemisphere damaged (LHD, RHD) patients, using voxel-based lesion-symptom mapping (VLSM). Our results show that voxel clusters where damage exerted a significant impact on balance, gait and lower-limb function were found in the corticospinal tract (CST), in its passage in the corona radiata and in the posterior limb of the internal capsule. An additional significant impact was found to lesions affecting the putamen and the external capsule (EC). Balance, gait, and hemiparetic lower limb function showed much overlap of the corresponding “significant” voxel clusters. Test scores of RHD and LHD patients were affected largely by damage to homologous regions, with the LHD group showing a wider distribution of “significant” voxels. The study corroborates and extends previous findings by demonstrating that balance control, gait, and lower limb function are all affected mainly by damage to essentially the same brain structures, namely—the CST and adjacent structures in the capsular-putaminal region.
Highlights
Falls occur in up to 70% of stroke victims during the first 6 months after discharge from hospital or rehabilitation setting (Forster and Young, 1995; Davenport et al, 1996; Weerdesteyn et al, 2008; Batchelor et al, 2012)
Used clinical measures [e.g., the Berg Balance Scale (BBS), Dynamic Gait Index (DGI) and Timed Up and Go (TUG)] focus on anticipatory balance control, that is essential for the maintenance of postural stability prior to voluntary movement by compensating for destabilizing forces associated with the movement
The aim of the current study was to examine the effect of stroke lesions on reactive and anticipatory balance control, gait, and lower limb function
Summary
Falls occur in up to 70% of stroke victims during the first 6 months after discharge from hospital or rehabilitation setting (Forster and Young, 1995; Davenport et al, 1996; Weerdesteyn et al, 2008; Batchelor et al, 2012). Recent studies assessed reactive balance control abilities by exposure to external perturbations delivered from a movable platform (Salot et al, 2015; Honeycutt et al, 2016; de Kam et al, 2017). In this paradigm, the time, direction and intensity of perturbation is unpredicted, simulating situations in real life where loss of balance is unexpected. PwS have shown substantially impaired reactive balance responses compared to healthy individuals, characterized by increased need for external assistance, difficulty initiating protective stepping with either lower limb, increased usage of multiple step strategy, and more falls into the harness system (Marigold and Eng, 2006; Mansfield et al, 2013; Martinez et al, 2013; Inness et al, 2014; Salot et al, 2015; Honeycutt et al, 2016; de Kam et al, 2017)
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