Abstract
Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.
Highlights
Stroke is a common cause of disability and residual physical impairments following a stroke and can pose a significant threat to quality of life (World Health Organization, 2018)
Modified Modified Ashworth Scale (MMAS) scores, Activities-Specific Balance Confidence Questionnaire, postural sway in the open and closed eyes conditions, timed up and go (TUG) test, ankle dorsiflexion passive range of motion (ROM), and ankle joint proprioception were measured in two post-stroke patient groups based on the level of ankle plantar flexor spasticity [i.e., High Spasticity Group (HSG) (MMAS > 2) and a Low Spasticity Group (LSG) (MMAS ≤ 2)]
We found no differences between the LSG and HSG groups in terms of balance confidence, dynamic balance, and ankle dorsiflexion ROM
Summary
Stroke is a common cause of disability and residual physical impairments following a stroke and can pose a significant threat to quality of life (World Health Organization, 2018). The sensorimotor and cognitive impairments following a stroke can have serious impacts on independence and activities of daily living (ADL) (Geurts et al, 2005). Of these stroke complications, impaired balance is critical for safe mobility, and any deficiencies in balance negatively affect gait, limit ADLs, and/or increases the risk of individuals falling (Paillex and So, 2005; Kollen et al, 2006; Van de Port et al, 2006). Spasticity is a common sensorimotor disorder defined neurophysiologically as a velocity-dependent increase in muscle tone and stretch reflex hypersensitivity (Lance, 1980). Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life
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