Abstract
BackgroundStroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death. The purpose of this study is to establish the relation between the outcome of instrumented posturography and of the most commonly used clinical balance tests, and investigate their role for obtaining reliable feedback on stroke patients’ balance impairment.MethodsRomberg test was performed on 20 subjects, 10 hemiplegic post-stroke subjects (SS, 69.4 ± 8.2 years old) and 10 control subjects (CS, 61.6 ± 8.6 years old), with 1 Bertec force plate. The following parameters were estimated from the centre of pressure (CoP) trajectory, which can be used to define subjects’ performance during the balance task: sway area; ellipse (containing 95% of the data); mean CoP path and velocity in the anterior-posterior and medio-lateral directions. The following clinical scales and tests were administered to the subjects: Tinetti Balance test (TB); Berg Balance test (BBT); Time up and go test (TUG), Fugl-Meyer (lower limbs) (FM), Motricity Index (lower limbs), Trunk Control Test, Functional Independence Measure. Comparison between SS and CS subjects was performed by using the Student t-test. The Pearson Correlation coefficient was computed between instrumental and clinical parameters.ResultsMean ± standard deviation for the balance scales scores of SS were: 12.5 ± 3.6 for TB, 42.9 ± 13.1 for BBT, 24 s and 75 cent ± 25 s and 70 cent for TUG. Correlation was found among some CoP parameters and both BBT and TUG in the eyes open and closed conditions (0.9 ≤ R ≤ 0.8). Sway area correlated only with TUG. Statistically significant differences were found between SS and CS in all CoP parameters in eyes open condition (p < 0.04); whereas in eyes closed condition only CoP path and velocity (p < 0.02) differed significantly.ConclusionsCorrelation was found only among some of the clinical and instrumental balance outcomes, indicating that they might measure different aspects of balance control. Consistently with previous findings in healthy and pathological subjects, our results suggest that instrumented posturography should be recommended for use in clinical practice in addition to clinical functional tests.
Highlights
Stroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death
Some of these tests and scales, which are described in detail in the Methods section, include the Fugl-Meyer scale (FM) [18]; the lower Motricity Index [19]; the Trunk Control Test (TCT) [20]; the Functional Independence Measure (FIM) [21,22,23,24]; the Tinetti Balance scale (TB) [7]; the Berg Balance Test (BBT) [24]; and the Time up and go Test (TUG) [17]
The observation that only some clinical and instrumental balance assessments are related might indicate that they measure different aspects of balance
Summary
Stroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death. Instrumented posturography has demonstrated its validity in monitoring balance, the use of force plates in the clinical practice is not yet common and simple test batteries and questionnaires to test balance and mobility are often employed as useful alternatives [7,11,17] Some of these tests and scales, which are described in detail, include the Fugl-Meyer scale (FM) [18]; the lower Motricity Index (lo-MI) [19]; the Trunk Control Test (TCT) [20]; the Functional Independence Measure (FIM) [21,22,23,24]; the Tinetti Balance scale (TB) [7]; the Berg Balance Test (BBT) [24]; and the Time up and go Test (TUG) [17]. The individual clinical functional tests do not reflect the complexity and multidimensional nature of balance [26]
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