Abstract
BackgroundSpinal cord injury (SCI) can damage long tracts, affecting postural stability. Impairments in balance have recently been proposed to be highly predictive of functional recovery in patients with SCI and thus merit evaluation. In addition to common observational clinical scales, more objective evaluation methods of balance can be implemented by analyzing center of pressure (COP) parameters using stabilometric platforms (SPs). COP analysis has been used in various pathologies, but the COP parameters with regard to measurement vary, depending on the features of the target population, and have only been assessed in healthy subjects. Specifically, concerning subjects with SCI, few studies have reported COP parameters, and none has addressed the reliability, validity, or responsiveness of this measure. The objective of this serial cross-sectional study was to analyze the reliability, validity, and responsiveness of COP parameters under various conditions in incomplete SCI subjects to assess balance.MethodsTwenty-three patients with incomplete SCI were examined 111 times for 1 year. Each session comprised administration of the Berg Balance scale, Tinetti scale, and WISCI scale and evaluation of stabilometric platform use. Stabilometry was performed under various sensory conditions (OF: open feet; CF: closed feet; OE: open eyes; CE: closed eyes), wherein several COP parameters were analyzed (L: COP path length; V: mean COP velocity, VAP: anteroposterior COP velocity; VLL: laterolateral COP velocity, A: COP ellipse area, SA1: x-axis of COP ellipse area; SA2: y-axis of COP ellipse area). The reliability, validity, and responsiveness of COP parameters that were associated with visual/support area conditions were analyzed.ResultsOf the COP parameters, V and arithmetically related measures had the highest reliability, validity, and effectiveness scores. Of all test conditions, OE-OF was the most valid, whereas CE-OF was the most responsive.ConclusionThe assessment of balance in SCI subjects can be reliable, valid, and effective in acquiring V data, based on OF-OE and OF-CE conditions and heel distance values.
Highlights
Spinal cord injury (SCI) can damage long tracts, affecting postural stability
Balance is usually defined as preservation of the vertical projection of the body’s center of mass (COM) onto the support area that is formed by the feet [1]
The inverted pendulum is regulated through the development of ground-reaction forces, the vector sum of which is applied to a point that is defined as the vertical projection of the COM onto the ground [3]: the center of pressure (COP)
Summary
Spinal cord injury (SCI) can damage long tracts, affecting postural stability. Concerning subjects with SCI, few studies have reported COP parameters, and none has addressed the reliability, validity, or responsiveness of this measure. Several afferent inputs, such as visual, vestibular, and somatosensory, are integrated and converted into efferent motor outputs, which in turn are transmitted down to the spinal cord along various motor tracts [5]. Postural sway, such as spontaneous shifts in the COP during quiet standing, represents the integrated output of complex interactions between systems [6]. Of the postural control systems, the spinal centers have a significant function, explaining the clinical relevance of postural control deficits in spinal cord injury (SCI) [8,9]
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