Postural Assessment Scale For Stroke Research Articles

Development and evaluation of the Primary Healthcare-based Physiotherapy Intervention and its effects on selected indices of stroke recovery

Aim: To develop a Primary Healthcare-Based Physiotherapy Intervention (PHCPI) that requires simple, inexpensive, easy-to-use equipment for stroke rehabilitation and evaluate its effects on selected clinical indices of recovery among post-acute stroke survivors over a 10-week period. Methods: Three databases (Medline, Pubmed and PEDro) were used to identify treatment approaches with proven efficacy. The authors synthesised these treatment approaches to develop the PHCPI, which was used in a repeated measure design involving 25 (mean age=60.6 ± 10.2 years) consenting individuals with first-incidence stroke. These individuals were treated at a primary health centre, twice weekly for 10 consecutive weeks. Outcomes were assessed using the Modified Motor Assessment Scale (MMAS), the Short Form Postural Assessment Scale for Stroke (SF-PASS) and the Reintegration to Normal Living Index (RNLI), before the intervention and fortnightly thereafter. Walking speed and quality of life were also assessed before the intervention and at week 10 of it. Results: Within-subject multivariate analysis, after controlling for gender, showed a significant increase in motor function, postural balance, walking speed and quality of life. Their community reintegration scores also improved over the period. Conclusion: The PHCPI resulted in improved motor function, community reintegration, walking speed, postural balance and quality of life among community-dwelling stroke survivors. This intervention can be used for stroke rehabilitation at primary health centres.

Stroke rehabilitation: should physiotherapy intervention be provided at a primary health care centre or the patients’ place of domicile?

Purpose: This randomized controlled trial compared the outcomes of physiotherapy intervention on selected indices of recovery for stroke survivors treated at a primary health centre group (PHCG) with those treated in their respective places of domicile group (DG). Methods: Participants were 52 individuals comprising 24 males and 28 females who had suffered a stroke and were recently discharged from two inpatient health facilities in Ibadan, Nigeria. They were randomly assigned into either the PHCG (n = 25) or DG (n = 27) and treated twice weekly for 10 consecutive weeks using a physiotherapy intervention protocol comprising a battery of task-specific exercises. The outcomes measured were motor function, balance and handicap assessed using the modified motor assessment scale (MMAS), short-form postural assessment scale for stroke (SF-PASS) and reintegration to normal living index (RNLI), respectively, as well as walking speed which was assessed using a standard technique. Results: Between-group comparison using the General Linear Model revealed no statistically significant difference in both the pre- and post-intervention scores of the two groups on the MMAS, SF-PASS, RNLI and walking speed in both PHCG and DG (p > 0.05). However, within-group comparison yielded a statistically significant difference in each of the indices of stroke recovery measured across the 10-week period in both groups. Conclusion: Physiotherapy intervention at the primary health care centre and respective homes of stroke survivors similarly improved clinical outcomes. Treatment at any of these locations may enhance access to physiotherapy after stroke in a low-income community like Nigeria.Implications for RehabilitationPhysiotherapy protocol comprising 10-week task-specific battery of exercises produced significant improvement in walking speed, balance, motor function and community reintegration of stroke survivors.Physiotherapy post-stroke can be provided at either a primary health centre or the domicile of the individual.In a low-income country like Nigeria, this will enhance access to this important service.

A Comparison of Two Balance Measures to Predict Discharge Performance From Inpatient Stroke Rehabilitation

To compare the admission Berg Balance Scale (BBS) and Postural Assessment Scale for Stroke (PASS) in predicting outcomes at discharge from an inpatient rehabilitation unit (IRU). We hypothesized that discharge outcomes would be better predicted by (1) the PASS compared with the BBS, and (2) by the PASS changing position subscore compared with the PASS maintain posture subscore. A retrospective study. An IRU in an academic medical center. Fifty-five subjects with stroke and mean (standard deviation [SD]) age of 71.5 ± 13.8 years, admission functional independence measures (FIM) of 57.2 ± 17.2 points, and IRU length of stay of 17.3 ± 9.7 days. METHODOLOGY/MAIN OUTCOME MEASUREMENTS: Admission and discharge BBS and PASS scores, gait velocity (GV) at discharge, and selected FIM items at discharge were measured. GV was analyzed both as a continuous and categorical variable. The Spearman rank correlation coefficient (r) was strong between admission BBS and PASS (r = 0.90, P < .0001). Correlations between admission BBS and PASS and discharge GV were 0.32 (P = .03) and 0.28 (P = .06), respectively. Analysis of variance was significant for both balance measures when grouped by the discharge gait speed category (P < .0001). Pairwise comparisons were significant between GV-A and the other 2 categories but not between GV-B and GV-C. The magnitude of the observed correlation with discharge GV was greater for PASS maintain posture subscore (r = 0.35, P = .02) than for PASS changing position subscore (r = 0.23, P = .13). Both subscores were significantly associated with both toileting and transfers (r = 0.43-0.56, all at least P ≤ .001). Contrary to our hypotheses, the BBS and PASS performed equally well in our study sample and were best at predicting patients discharged in the slowest GV category. There were few differences between the PASS subscores. Further research should compare how well admission BBS and PASS predict gait velocity, falls, and other functional parameters in the community after IRU discharge.

Responsiveness and Predictive Validity of the Hierarchical Balance Short Forms in People With Stroke

The lack of knowledge about the responsiveness and predictive validity of a set of Hierarchical Balance Short Forms (the HBSF) in people with stroke limits the utility of the HBSF in both clinical and research settings. The purpose of this study was to investigate the responsiveness and predictive validity of the HBSF in people receiving inpatient rehabilitation after stroke. A prospective cohort study was conducted. Sixty-six participants completed both the 6-item HBSF and the 12-item Postural Assessment Scale for Stroke (PASS) after admission to the rehabilitation ward and before hospital discharge. The standardized effect size (ES) and the standardized response mean (SRM) were used to investigate the internal responsiveness of the HBSF and the PASS. Changes in the Barthel Index and the mobility subscale of the Stroke Rehabilitation Assessment of Movement were used as the external criteria for examining external responsiveness. Moreover, the admission scores on the HBSF and the PASS and the discharge scores on the Barthel Index and mobility subscale of the Stroke Rehabilitation Assessment of Movement were analyzed to investigate the predictive validity of the 2 balance measures. The internal responsiveness of the HBSF was high (ES>0.9, SRM>1.6). The SRM of the HBSF was significantly larger than that of the PASS, whereas the ES of the HBSF was not significantly larger than that of the PASS. The external responsiveness and predictive validity of the HBSF were sufficient and similar to those of the PASS (external responsiveness: r≥.35; predictive validity: r≥.67). The convenience sampling of people receiving inpatient rehabilitation after stroke may limit the generalization of the results. The HBSF has sufficient responsiveness and predictive validity in people receiving inpatient rehabilitation after stroke and is thus recommended for both clinicians and researchers.

Responsiveness of 2 Scales to Evaluate Lateropulsion or Pusher Syndrome Recovery After Stroke

Clark E, Hill KD, Punt TD. Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke. Objectives To analyze responsiveness to change of 2 outcome measures in the lateropulsion population after stroke. Lateropulsion describes an atypical balance problem after stroke where patients actively push themselves toward their paretic side. Secondary aims were to measure the incidence of lateropulsion and evaluate the site of the brain most commonly involved in lateropulsion. Design Stroke patients were screened for lateropulsion on admission to rehabilitation. Those demonstrating lateropulsion were assessed every 2 weeks using 2 scales to measure progress. Analysis of variance and the standardized response mean (SRM) were used to analyze change for each scale. Setting Rehabilitation and geriatric units. Participants Prospective purposive sample of stroke patients (N=43) demonstrating lateropulsion on admission from a consecutive admission sample of 160. To allow comparison, data from 43 stroke patients who did not display lateropulsion were collected retrospectively, matched on age (±5y) and sex. Interventions Not applicable. Main Outcome Measures Incidence of lateropulsion was calculated as a percentage of stroke patients admitted. Responsiveness to change was measured by using the Burke Lateropulsion Scale (BLS), to quantify severity of lateropulsion, and the Postural Assessment Scale for Stroke (PASS), which measures postural abilities. Results Of 160 stroke patients, 26.9% displayed lateropulsion (mean age, 72y; 51% men). The BLS and PASS had high levels of measurement responsiveness (BLS SRM =1.48 and 2.24; PASS SRM =1.76 and 1.87) at 4 and 8 weeks, respectively. Conclusions The BLS and PASS are responsive scales to monitor progress and recovery during rehabilitation. As more than 25% of stroke patients admitted to rehabilitation may exhibit lateropulsion, these 2 scales could be valuable in monitoring progress and designing future intervention studies.

이중과제 훈련이 만성뇌졸중 환자의 자세안정성과 균형에 미치는 효과

The purpose of this study was to investigate the effect of dual task training on postural stability and balance in chronic stroke patients. A total of 25 ambulatory hemiplegic stroke patients were recruited into this study and randomly assigned into two groups, the dual task training group (n=13) and control group (n=12). Both groups received general physical therapy for 30 minutes a day, 5 days a week during 6 weeks. In addition, dual task training group received dual task training programs for 50 minutes a day, 3 days a week during 6 weeks. The scores of Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS) and postural sway with eye opened and eye closed on the Force Plate were assessed before and after intervention. Postural stability and balance significantly improved after training in the dual task training group(p<0.05). The result suggests that dual task training is feasible and suitable for individual with chronic stroke.

The Effect of Wheelchair Exercise on Physical Function and Health Status by Duration of Stroke Patients

Stroke is the leading cause of disability in adults worldwide. Evidence is growing on the efficacy of exercise for improving physical fitness and physiological health in stroke patients. PURPOSE: The purpose of this study was to investigate the effect of wheelchair exercise on the physical function and health status according to the duration of stroke patients. METHODS: Eighteen people were randomly selected and divided into short duration of stroke group (9.90±1.72months) and long duration of stroke group (18.62±3.06months). Wheelchair exercise was progressed with 60 min per session, five times per week for six-weeks. Physical function such as flexibility, agility, grip strength, lower-body muscular endurance, and postural assessment scale for stroke (PASS), health status (SF-36) measured at baseline and after a six-week exercise program. The analyses were made using two-way ANOVA with repeated measures. RESULTS: The result showed that significantly improved on flexibility (0.1±13.24cm vs. 8.46±9.94cm, p<0.000), agility (23.50±9.20sec vs. 17.95±8.62sec, p<0.05), grip strength (26.39±6.67kg vs. 28.47±6.56, p<0.05), lower-body muscular endurance (6.3±4.13N vs. 7.7±4.87N, p<0.05), and PASS (28.30±7.32 vs. 29.70±8.0, p<0.01) to the short of duration stroke patients after wheelchair exercise program. Health status were significantly improved on physical functioning (19.50±19.78 vs. 23.00±19.74, p<0.05), role limitation physical (22.50±41.58 vs. 32.50±39.17sec, p<0.01), body pain (41.55±27.08 vs. 61.95±30.08, p<0.01), social functioning (27.05±18.06 vs. 43.05±20.75, p<0.01), role limitation emotional (10.00±31.62 vs. 37.50±51.75, p<0.05), mental health (60.20±15.61 vs. 69.00±16.26, p<0.05), and general health (40.50±17.39 vs. 53.50±15.64, p<0.01) to the short of duration stroke patients after wheelchair exercise program. CONCLUSIONS: Six-week wheelchair exercise was positive effect of physical function and health status on only the short duration of stroke patients. We suggested that exercise rehabilitation program for chronic stroke patients and for useful their improved of quality of life.

Functional recovery of patients with brain tumor or acute stroke after rehabilitation: A comparative study

The aim of this study was to compare the locomotor functional recovery of patients with brain tumor and patients with stroke. Each patient with a brain tumor was matched to a patient with stroke according to the lesion side. Twenty-one patients operated for intracranial tumors and 21 patients with stroke were studied. The mean ages (± standard deviation) of patients were 52.5 ± 16 years for patients with brain tumor and 56.7 ± 11 years for patients with stroke. For each patient, the age, gender, presence of aphasia, smoking habit, co-morbidities, lesion origin and lesion size (for the brain tumor group) were recorded. Locomotor and functional recovery were evaluated by using the Postural Assessment Scale for Stroke, the Berg Balance Scale, Motor Assessment Scale and the mobility section of the Functional Impairment Measure. There was no difference regarding demographic characteristics between the two groups. After rehabilitation both groups had significantly improved in terms of all parameters, but the extent of improvement did not differ between the two groups.

Altered Trunk Position Sense and Its Relation to Balance Functions in People Post-Stroke

To determine whether trunk position sense is impaired in people with poststroke hemiparesis. Good trunk stability is essential for balance and extremity use during daily functional activities and higher level tasks. Dynamic stability of the trunk requires adequate flexibility, muscle strength, neural control, and proprioception. While deficits of trunk muscle strength have been identified in people post-stroke, it is not clear whether they have adequate postural control and proprioception to ensure a stable foundation of balance to enable skilled extremity use. Trunk position sense is an essential element of trunk postural control. Even a small impairment in trunk position sense may contribute to trunk instability. However, a specific impairment of trunk position sense has not been reported in people post-stroke. Twenty subjects with chronic stroke and 21 nonneurologically impaired subjects participated in the study. Trunk repositioning error during sitting forward flexion movements was assessed using an electromagnetic movement analysis system, Flock of Birds. Subjects post-stroke were also evaluated with clinical measures of balance (Berg Balance Scale), postural control (Postural Assessment Scale for Stroke), and extremity motor impairment severity (Fugl-Meyer Assessment-Motor Score). There were significant differences in absolute trunk repositioning error between stroke and control groups in both the sagittal (P = 0.0001) and transverse (P = 0.0012) planes. Mean sagittal plane error: post-stroke: 6.9 +/- 3.1 degrees, control: 3.2 +/- 1.8 degrees; mean transverse plane error: post-stroke 2.1 +/- 1.3 degrees, control: 1.0 +/- 0.6 degrees. There was a significant negative correlation between sagittal plane absolute repositioning error and the Berg Balance Scale score (r = -0.49, P = 0.03), transverse plane absolute repositioning error and Berg Balance Scale score (r = -0.48, P = 0.03), and transverse plane repositioning error and the Postural Assessment Scale for Stroke score (r = -0.52, P = 0.02) Subjects with poststroke hemiparesis exhibit greater trunk repositioning error than age-matched controls. Trunk position sense retraining, emphasizing sagittal and transverse movements, should be further investigated as a potential poststroke intervention strategy to improve trunk balance and control.

A Comparison of Psychometric Properties of the Smart Balance Master System and the Postural Assessment Scale for Stroke in People Who Have Had Mild Stroke

Chien C-W, Hu M-H, Tang P-F, Sheu C-F, Hsieh C-L. A comparison of psychometric properties of the Smart Balance Master system and the Postural Assessment Scale for Stroke in people who have had mild stroke. Objective To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. Design One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients’ comprehensive activities of daily living (ADL) function. Setting Three rehabilitation units in Taiwan. Participants Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. Interventions Not applicable. Main Outcome Measures Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. Results For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78−.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [ d], .63) and small ( d range, .27−.33), respectively, whereas the responsiveness of the weight-shifting tests was limited ( d range, .04−.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function ( r 2 range, .15−.17). The PASS showed high reliability (ICC=.84) and small responsiveness ( d=.41), and the PASS in the second evaluation had acceptable predictive validity ( r 2=.24). Conclusions The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.

Influence of subjective visual vertical misperception on balance recovery after stroke

Background: Subjective visual vertical (SVV) perception can be perturbed after stroke, but its effect on balance recovery is not yet known. Aim: To evaluate the influence of SVV perturbations on...

Subjective Visual Vertical Perception Relates to Balance in Acute Stroke

Bonan IV, Guettard E, Leman MC, Colle FM, Yelnik AP. Subjective visual vertical perception relates to balance in acute stroke. Objective To determine whether misperception of the subjective visual vertical (SVV) underlies balance difficulties in hemiplegic patients. Design Descriptive study, using a convenience sample. Setting Department of physical medicine of a university hospital. Participants Thirty inpatients with hemiplegia after a hemispheric stroke during the 3 previous months. Interventions Not applicable. Main Outcome Measures The SVV was tested while subjects sat in a dark room and were asked to adjust a luminous line to the vertical position. Mean SVV deviation and uncertainty, defined as the standard deviation, were calculated for 8 trials. Balance was assessed by the Postural Assessment Scale for Stroke (PASS) and while patients sat on a laterally rocking platform placed on a Satel force platform. The mean body position and the instability score (Lx), calculated as the length of the course of the center of pressure, were recorded. Functional outcome was also evaluated by the FIM instrument. Results An abnormal SVV was recorded for 20 of 30 patients. Balance (ie, PASS, Lx) and FIM correlated significantly with SVV tilt ( P<.001, P=.01, and P<.001, respectively) and with uncertainty (PASS, P=.006; FIM, P=.003). Conclusions Verticality misperception was related to poor balance and might be an important element in the assessment of contributing factors to balance disorders after stroke. It should probably be taken into account when establishing balance rehabilitation programs for patients with hemiplegia.

Dépendance visuelle après accident vasculaire cérébral récent

Introduction. – After chronic stroke, inability to use pertinent somatosensory or vestibular information have been described. The aim of the study was to determine whether visual dependence occurred early after stroke before rehabilitation. Method. – Thirty patients with recent hemiplegia (16 right and 14 left hemispheric stroke) performed the rod and frame test (RFT). Patients were asked to adjust the rod to the vertical position under 3 conditions: basically, with a frame tilted 18° to the right and then with the frame tilted to the left. Bias in each condition (mean, SD) was recorded and compared to adjustments of the rod by 23 controls. Motor control, sensibility, functional level (functional independence measure), age, neglect, and then balance by the postural assessment scale for stroke were assessed. Results. – Fifty-six per cent (17/30) of patients but only 26% of controls were influenced by the tilt of the frame on the 2 sides (visual dependence). No correlation was found between visual dependence and the characteristics of the patients. Discussion. – Many patients with recent hemiplegia seem to rely on visual input. The mechanisms of such visual dependence are discussed. Rehabilitation programs should take into account the possible impairment of sensory organisation and should include exercises to be performed under visual disturbances.

Évaluation de l'équilibre en pathologie neurologique et gériatrique

Objective. – To analyse the clinical usefulness and metrological properties of the main techniques and indices used to assess balance disorders. Methods. – More than 4000 abstracts referenced in MEDLINE and dealing with postural control and postural disorders (wide screening) were reviewed to determine the main postural techniques and indices used in a clinical context. We retained abstracts with a high citation frequency and those with interesting findings. Corresponding key words were identified for a specific search of articles that we analysed. Results. – Postural assessment tools can be classified as scales of ordinal items, tests based on metric or chronometric measurement, posturography, and verticality perception. These techniques are complementary, and their association is recommended in a clinical context. Regarding generic tools, the Falls-related Efficacy Scale (FES) and the Activities-specific Balance Confidence scale (ABC scale) would be enhanced if comparatively analysed and reworked to allow for a feasible and reliable assessment of the fear of falling. Despite a wide diffusion in numerous postural fields worldwide, the Berg Balance Scale (BBS) and the Functional Reach Test (FRT) do not have the required criteria to remain the gold standards they were in the 1990 s. Static posturography should be normalised and yield more reliable indices. The clinical relevance of the subjective assessement of visual, haptic, and postural verticals are questionable, especially to explain postural disability. Regarding specific tools, the Tinetti test (TT) and the Time Up and Go test (TUG) are the most suited to assess postural capacities in very elderly people, in whom the predictive validity of the postural assessment of falls is still modest. In stroke patients, the Postural Assessment Scale for Stroke (PASS), posturography, lateropulsion assessment, and vertically perception are interesting and complementary techniques. Postural assessment relies mainly upon the 5 postural items of the Unified Parkinson Disease Rating Scale (UPDRS) in people with Parkinson disease and upon the Romberg test and posturography in patients with cerebellar or proprioceptive ataxia. Some novel postural scales for patients with multiple sclerosis or spinal cord injury are also emerging. Conclusion. – Among numerous tools that contribute to the assessment of postural disorders, only the most recent ones (developed in the last 10 years) have undergone complete validation. It is now crucial to compare these tools, not only in terms of reproducibility and internal consistency, but also overall, in terms of feasibility, responsiveness, and predictive validity for a given population.