Sway Index Research Articles

Ocular dominance and balance performance in healthy adults

Purpose To evaluate the effect of ocular dominance on balance performance in healthy adult subjects. Methods Ocular dominance was determined in 24 healthy subjects using the hole-in-the-paper test. Balance function was evaluated by computerized dynamic platform posturography (CDPP). Sway index (SI), antero-posterior sway (APS) and lateral sway (LS) were served as outcome parameters. Results The outcome parameters did not differ significantly between dominant and non-dominant eye fixation both in static and angular balance tests (SI—5.47 ± 0.42, 6.23 ± 0.52, p = 0.146 and 18.4 ± 1.07, 19.11 ± 1.15, p = 0.142, respectively; APS—−2.26 ± 4.68, −5.1 ± 4.6, p = 0.082 and −1.94 ± 3.33, −3.64 ± 2.6, p = 0.48, respectively; LS—−1.21 ± 1.46, −1.12 ± 1.66 p = 0.94 and −1.98 ± 1.16, −1.55 ± 1.39, p = 0.69, respectively). Conclusions Ocular dominance does not seem to affect postural function in the monovision and far viewing condition.

The gait and balance of patients with diabetes can be improved: a randomised controlled trial

Aims/hypothesisGait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients.MethodsThis was a randomised controlled trial (n = 71) with an intervention (n = 35) and control group (n = 36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up.ResultsThe trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p < 0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down.Conclusions/interpretationSpecific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients’ physical activity levels and quality of life.Trial registration:ClinicalTrials.gov NCT00637546Funding:This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-009-1592-4) contains supplementary material, which is available to authorised users.

Analysis of the postural stability in individuals with or without signs and symptoms of temporomandibular disorder

The objective of this study was to evaluate the stability and the distribution of weight of individuals with TMD (Temporomandibular Disorder) when placed in an orthostatic position. Forty female volunteers, participating in this study, were distributed into a control and a TMD group. Clinical examinations of the craniomandibular system and of the neck were performed. Postural stability was evaluated using a stabilographic platform. Through this system, the sway index (SI), the maximum medial-lateral distance (MMLD), the maximum anterior-posterior distance (MAPD) and the medial-lateral symmetry (MLS) could be determined. Tests were performed in the mandibular rest position and during isometric and isotonic contraction. The variables were analyzed through repeated measures ANOVA. The level of significance was p < 0.05. The results of this study indicate that individuals with TMD present more pain in the cervical region (p < 0.05). The group with TMD showed a significant reduction in SI (p < 0.05), MMLD (p < 0.05) and MLS (p < 0.01). Individuals with TMD presented greater postural asymmetry, and cervical pain demonstrated a potential link with an increase in postural stability.

P004 Weight-bearing deficits following anterior cruciate ligament reconstruction

This study was designed as a comparison study of two cohorts.The hypothesis of this study was that soccer players and dancers have different balance abilities and that these differences could be objectively measured using center of pressure measurements.Center of pressure (COP) measurements are reproducible and have been validated in the literature for assessing standing balance. The literature does not provide sensitive enough techniques for discriminating between two groups of athletes with excellent standing balance.A Matscan pressure mat (Tekscan, Boston, MA) was used to compare COP change variability between 32 female collegiate soccer players and 32 dancers. COP was used to calculate sway index, center acquisition time, sway path length and sway velocity as measures of standing balance.The dancers had significantly better balance scores (p < 0.05) in 5 of 20 balance tests. Results for the remaining 15 balance tests were not significantly different.These data show that standing balance characteristics of dancers and soccer players can be objectively measured using COP data. Dancers have certain standing balance abilities that are better than those of soccer players. The COP measurements in this study can be used as a tool in future studies investigating standing balance in different groups of athletes.

Sway ratio - a new measure for quantifying postural stability.

In the search of a reliable postural stability index, two sway time series: the center-of-mass (COM) and the center-of-foot pressure (COP) were recorded simultaneously in elderly subjects standing quiet with eyes open and with eyes closed. From a battery of commonly use sway measures, only the anteroposterior COM and the COP path lengths proved their high sensitivity and discriminative power to the imposed vision conditions. Based upon these indices, a new measure - sway ratio (SR) - was computed, as the COP-to-COM path length ratio. The measure can easily distinguish vision vs. no vision in the elderly. The SR can be successfully accessed base upon the COP signal only. In contrast to traditional sway indices, the SR as a relative measure is insensitive to the length of sampled record and to the signal sampling frequency. Its magnitude can be interpreted as an average amount of balance controlling motor activity that coincides with a unit COM displacement. The SR is recommended as a reliable measure that allows for assessment of postural stability.

Assessment of postural instability in patients with Parkinson’s disease

Postural instability is one of the most disabling features of idiopathic Parkinson's disease (PD). In this study, we focused on postural instability as the main factor predisposing parkinsonians to falls. For this purpose, changes in sway characteristics during quiet stance due to visual feedback exclusion were studied. We searched for postural sway measures that could be potential discriminators for an increased fall risk. A group of 110 subjects: 55 parkinsonians (Hoehn and Yahr: 1-3), and 55 age-matched healthy volunteers participated in the experiment. Their spontaneous sway characteristics while standing quiet with eyes open and eyes closed were analyzed. We found that an increased mediolateral sway and sway area while standing with eyes closed are characteristic of parkinsonian postural instability and may serve to quantify well a tendency to fall. These sway indices significantly correlated with disease severity rated both by the Hoehn and Yahr scale as well as by the Motor Section of the UPDRS. A forward shift of a mean COP position in parkinsonians which reflects their flexed posture was also significantly greater to compare with the elderly subjects and exhibited a high sensitivity to visual conditions. Both groups of postural sway abnormalities identified here may be used as accessible and reliable measures which allow for quantitative assessment of postural instability in Parkinson's disease.

Effects of experience in a dynamic environment on postural control

Background:Surfing is a balance-reliant, open skill performed in a dynamic environment rich in visual, somatosensory and vestibular information.Objective:To evaluate adaptations to the postural control system by surfing experience.Methods:Postural control was...

Comparison of standing balance between female collegiate dancers and soccer players

Study design This study was designed as a comparison study of two cohorts. Objectives The hypothesis of this study was that soccer players and dancers have different balance abilities and that these differences could be objectively measured using center of pressure measurements. Background Center of pressure (COP) measurements are reproducible and have been validated in the literature for assessing standing balance. The literature does not provide sensitive enough techniques for discriminating between two groups of athletes with excellent standing balance. Methods and measures A Matscan pressure mat (Tekscan, Boston, MA) was used to compare COP change variability between 32 female collegiate soccer players and 32 dancers. COP was used to calculate sway index, center acquisition time, sway path length and sway velocity as measures of standing balance. Results The dancers had significantly better balance scores ( p < 0.05) in 5 of 20 balance tests. Results for the remaining 15 balance tests were not significantly different. Conclusion These data show that standing balance characteristics of dancers and soccer players can be objectively measured using COP data. Dancers have certain standing balance abilities that are better than those of soccer players. The COP measurements in this study can be used as a tool in future studies investigating standing balance in different groups of athletes.

Static Standing Trunk Sway Assessment in Amputees – Effects of Sub-Threshold Stimulation

Sub-threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans-tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans-tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub-threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co-ordinates for the determination kinematic data (sway distance) of the center of mass (COM) on second sacral (S2) were collected using an ultrasound-based Zebris CMS-HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation in amputees. To test this hypothesis, a computerized sub-threshold low-level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance) and increase in single leg support time index during single leg quiet standing by applying sub-sensory stimulation. The single leg quiet standing test findings suggest that sub-threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

Balance performance in adult epilepsy patients

To evaluate the magnitude of subclinical balance dysfunction in adult epilepsy patients and to assess the relative contribution of different variables to balance impairment. Balance performance was evaluated by computerized dynamic platform posturography (CDPP) in 25 adult patients following a generalized tonic-clonic seizure (GTCS) and in 11 healthy subjects. The GTCS was a breakthrough seizure in 20 patients with epilepsy and a first seizure in 5. Seven of the patients had localization-related epilepsy and 13 had generalized epilepsy. Mean epilepsy duration was 6.6 years. Nineteen of the patients were treated with antiepileptic drugs (AEDs), 16 on monotherapy and three on polytherapy. Brain CT scan and EEG abnormalities were found in 7 and 14 patients, respectively. None of the patients had clinical signs of balance dysfunction. Postural function, measured by Sway Index (SI), was worse in the patients compared to controls. A lower SI was found in patients who did not receive AEDs, had one or two seizures, had a disease duration of less than a year and had a generalized epilepsy. Although the study group was small and heterogeneous and only a small number of parameters have reached statistical significance, it seems that posturography can be helpful in the evaluation of postural stability in adult patients with epilepsy.

Balance problems after unilateral lateral ankle sprains

Abstract-Ankle ligament injury is the most common injury in athletic activities. This study examined balance problems in athletes with acute lateral ankle sprains. Thirty male athletes aged 20 to 35 years with right dominant side and traumatic ankle sprain were recruited through simple nonprobability sampling. We measured the sway index and limits of stability with the Biodex Balance System under different conditions. Functional balance was evaluated with two clinical tests: the Functional Reach Test and the Star-Excursion Balance Test. The results showed that balance ability in patients with acute lateral ankle sprain was significantly weaker under closed- versus open-eye conditions. Symmetry of weight-bearing on involved and sound limb in bilateral standing was not significantly different, but weight-bearing on the nondominant limb was significantly higher than on the dominant limb. We can conclude that balance problems occur after acute ankle sprains because of proprioception deficits and that the unconscious (reflexive) aspect of proprioception is more severely affected than the conscious (voluntary) aspect.

The Effect Of Textured Plantar Surfaces On Postural Stability

PURPOSE Balance training has become an integral part of therapeutic exercise interventions. Based on his clinical observations, Janda (1996) suggested using textured surfaces on the sole of the foot to stimulate the plantar cutaneous mechanoreceptors, increasing proprioceptive information into the central nervous system during balance training. The purpose of this pilot study was to determine the effects of a textured plantar surface on postural sway compared to a non-textured, flat surface. METHODS Eight orthopaedic physical therapy patients (4 males, 4 females, ages 22–58) performed a modified clinical test of sensory integration and balance (mCTSIB) using computerized posturography. Subjects stood without shoes (wearing socks) on a specially designed textured surface made out of PVC, with nodule width of 4.5 mm, height of 7.0 mm, and density of 9 nodules per 6.5 cm2. The mCTSIB consisted of three trials of each: eyes open flat surface, eyes open textured surface, eyes closed flat surface, and eyes closed textured surface. Sway velocity, sway amplitude, and sway index were compared on the flat and textured surfaces. RESULTS Due to the low number of subjects for this pilot study and high variability between subjects, statistical significance between the textured and flat surfaces could not be determined. However, comparison of descriptive data revealed that subjects demonstrated less increase in postural sway with eyes closed while standing on the textured surface compared to the flat surface (a higher sway index indicates more postural sway). The mean change in sway index with eyes closed between flat and textured surfaces was +.01, and +.11 with eyes open. Additionally, greater sway was observed during the flat condition as subjects went from the eyes open to eyes closed conditions. Mean change in sway index from eyes open to closed on textured was +.15, and +.23 on the flat surface. CONCLUSIONS The results of this pilot testing indicate a trend in which postural sway with textured surfaces only slightly increases as they subject moves from eyes open to eyes closed, compared to larger increases on flat surfaces. It is hypothesized that the textured surfaces help replace the loss of visual input to maintain postural stability by increasing afferent proprioceptive input into the sole of the foot. Consequently, the expected increase in postural sway from eyes open to eyes closed conditions may be attenuated by the textured surface. Future research should include additional subjects and investigate the effect of different textured surfaces on postural sway.

The Effect Of Textured Plantar Surfaces On Postural Stability

PURPOSE Balance training has become an integral part of therapeutic exercise interventions. Based on his clinical observations, Janda (1996) suggested using textured surfaces on the sole of the foot to stimulate the plantar cutaneous mechanoreceptors, increasing proprioceptive information into the central nervous system during balance training. The purpose of this pilot study was to determine the effects of a textured plantar surface on postural sway compared to a non-textured, flat surface. METHODS Eight orthopaedic physical therapy patients (4 males, 4 females, ages 22–58) performed a modified clinical test of sensory integration and balance (mCTSIB) using computerized posturography. Subjects stood without shoes (wearing socks) on a specially designed textured surface made out of PVC, with nodule width of 4.5 mm, height of 7.0 mm, and density of 9 nodules per 6.5 cm2. The mCTSIB consisted of three trials of each: eyes open flat surface, eyes open textured surface, eyes closed flat surface, and eyes closed textured surface. Sway velocity, sway amplitude, and sway index were compared on the flat and textured surfaces. RESULTS Due to the low number of subjects for this pilot study and high variability between subjects, statistical significance between the textured and flat surfaces could not be determined. However, comparison of descriptive data revealed that subjects demonstrated less increase in postural sway with eyes closed while standing on the textured surface compared to the flat surface (a higher sway index indicates more postural sway). The mean change in sway index with eyes closed between flat and textured surfaces was +.01, and +.11 with eyes open. Additionally, greater sway was observed during the flat condition as subjects went from the eyes open to eyes closed conditions. Mean change in sway index from eyes open to closed on textured was +.15, and +.23 on the flat surface. CONCLUSIONS The results of this pilot testing indicate a trend in which postural sway with textured surfaces only slightly increases as they subject moves from eyes open to eyes closed, compared to larger increases on flat surfaces. It is hypothesized that the textured surfaces help replace the loss of visual input to maintain postural stability by increasing afferent proprioceptive input into the sole of the foot. Consequently, the expected increase in postural sway from eyes open to eyes closed conditions may be attenuated by the textured surface. Future research should include additional subjects and investigate the effect of different textured surfaces on postural sway.

Postural control of patients with hemiparesis: force plates measurements based on the clinical sensory organization test

Standing balance of hemiparetic patients is characterized by increased sway and an asymmetrical weight bearing distribution. The objectives of the study were to determine the feasibility of using a modified clinical sensory organization test with patients following a stroke and to evaluate the contribution of visual and somatosensory input to the standing balance of hemiparetic patients during the first two months following a stroke. Thirty patients with hemiparesis underwent functional and posturographic testing one and two months following their stroke. Testing was conducted in six stance conditions differing in somatosensory and visual input. Fifteen age-matched non-impaired subjects served as the control group. Sway Index (SI) representing the displacement of the subjects’ center of pressure during stance, was generally affected by time (p = 0.003), visual input (p = 0.0001), and somatosensory input (p = 0.0061), with the effect of vision significantly greater in the patient group as compared with the control group (p = 0.0006). Despite significant functional gains in the Barthel Index and functional ambulation (p = 0.01), percentage of body weight on the involved extremity (%BW) by stance condition did not change over time. Posturographic testing is useful for determining the sensory organization abilities of stroke patients with moderate impairment and indicates that these patients are dependent on visual input for postural control. The decrease in %BW borne on the affected extremity does not change over time or with the varying of sensory input.

Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing.

To quantitatively evaluate the difference of posture control in sitting position between children with spastic cerebral palsy and normal subjects. Twenty children with spastic cerebral palsy who could sit independently and 20 age- and sex-matched normal children were enrolled. The Chatteex Balance System was used to evaluate static and dynamic posture control as the subjects were sitting on a bench. The sway distance in sagittal and lateral directions, sway ratio, and sway index in both the static and dynamic sitting positions were recorded by the Chatteex Balance System. There was a significantly lower static and dynamic sway ratio and a greater static sway index and dynamic lateral sway distance in the study group. The dynamic sway index in the study group was greater than the index in the control group, although it did not reach statistical significance. Children with diplegic cerebral palsy did perform significantly worse in sitting posture control compared with normal subjects of similar chronological age. The sway index and sway ratio proved to be the objective and sensitive indicators that can be used to distinguish children with cerebral palsy from normal peer groups.

ATTENTIONAL DEMANDS OF BALANCE IN OLDER ADULTS.

There is general agreement that the attentional demands for static balance increase with age. Research suggests that age-related decrease in balance may increase the attentional demands associated with maintaining stability. The “posture-first” hypothesis purports that when a person is engaged in both cognitive and postural tasks, attention will be allocated to postural control (Cordo and Nashner, 1982). PURPOSE: The purpose of this study was to determine the effects of two tasks, one attentionally demanding the other more automatic, on static balance in older adults. METHODS: The static balance of seven (75.7 ± 7.1) older adults was evaluated under 3 conditions (No STROOP [NS], Word STROOP [WS], and Color STROOP [CS]). The STROOP task presents words printed in mismatching colors (e.g. “red” presented in blue ink). Participants are instructed to read aloud the word (WS) or the color the word is printed in (CS). The CS task is a much more difficult and attentionally demanding task. Balance measures obtained during each of the STROOP conditions were Sway Index (SI), Sway Amplitude A-P plane (Amp-AP), Sway Amplitude M-L plane (Amp-ML), Sway Speed A-P plane (Spd-AP) and Sway Speed M-L plane (Spd-ML). RESULTS: Paired-sampled t-tests were used to compare static balance measures for the STROOP conditions. There were no significant static balance differences between the NS and WS conditions suggesting that simply speaking does not impact static balance. Sway Amplitude and Speed measures were found to be significant in the M-L plane and not in the A-P plane. Significant (p < 0.05) differences for SI, Amp-ML and Spd-ML were found between the NS and SC and WS and CS conditions. CONCLUSION: The results of this study indicate that an attentionally demanding task (CS), but not a more automatic task (WS), negatively impacts static balance. Balance becomes impaired as the task becomes increasingly difficult (NS > WS > CS). This does not support the “posture-first” hypothesis, but the balance task may not have conveyed a threat to one's balance and thus more attention was allocated to the cognitive task.

Effect of a 4-Week Agility-Training Program on Postural Sway in the Functionally Unstable Ankle

Context:Agility training has been proposed as an important tool in rehabilitation. However, it is unclear which types of agility training are most useful.Objective:To assess the effects of agility training on balance in individuals with functionally unstable ankles.Design:A 2-group experimental design with repeated measures.Setting:Laboratory.Patients:Twenty college-aged volunteers, each with 1 functionally unstable ankle, were randomly assigned to 1 of 2 groups.Interventions:Subjects in the experimental group performed agility training 3 times per week for 4 weeks.Main Outcome Measures:Subjects were tested for static single-leg balance before and after the training period. Anterior/posterior sway amplitude, medial/lateral sway amplitude, and sway index were assessed using the Chattex Balance System.Results:No significant differences in balance were found after the agility training.Conclusions:Agility training did not improve static single-leg balance in subjects with functionally unstable ankles.

Validity of weight distribution and sway measurements of the Balance Performance Monitor.

The Balance Performance Monitor (BPM) is a device which provides auditory and visual feedback on weight distribution and the magnitude of lateral and anterior-posterior sway during quiet standing. This study investigated the validity of the measurements provided by the BPM using a Kistler force plate (KFP) as the gold standard. Percentage weight distribution between the BPM foot plates was validated using both a series of calibration weights and the vertical component of ground reaction force, measured by the KFP, during normal standing in 18 young normal subjects. The lateral and anterior-posterior sway indices from the BPM were validated against the standard deviation of the position of the centre of pressure, again obtained using the KFP, during normal standing with eyes open and eyes closed and standing with feet together with eyes open. Concurrent validity of the percentage weight distribution measurements was assessed by calculating the 'limits of agreement' between the corresponding measurements from the BPM and KFP and the 95% confidence intervals for these 'limits'. Differences in the units of measurement obtained from the BPM and KFP resulted in the concurrent validity of the sway indices being assessed using correlation and regression. Excellent agreement was found between the percentage weight distribution values provided by the BPM and the KFP, which showed that the BPM may read only 3% of body weight above or below that given by the KFP. High correlations (r = 0.61-0.99) were found between both the lateral and anterior-posterior sway indices from the BPM and the motion of the centre of pressure from the KFP in the respective direction. Despite this, further analysis of regression equations and the 95% prediction intervals showed poor concurrent validity of the BPM sway indices in relation to KFP measurements. This was thought to be due to the different methods by which the sway indices and the motion of the centre of pressure were calculated. The BPM may be used to provide a valid measure of the symmetry aspect, but not necessarily the steadiness aspect of postural control.

Static Standing Trunk Sway Assessment in Amputees – Effects of Sub‐Threshold Stimulation

Sub‐threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans‐tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans‐tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub‐threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co‐ordinates for the determination kinematic data (sway distance) of the center of mass (COM) on second sacral (S2) were collected using an ultrasound‐based Zebris CMS‐HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub‐sensory stimulation in amputees. To test this hypothesis, a computerized sub‐threshold low‐level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance) and increase in single leg support time index during single leg quiet standing by applying sub‐sensory stimulation. The single leg quiet standing test findings suggest that sub‐threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients

Objectives: To evaluate the effects of an anterior ankle-foot orthosis (AFO) on static and dynamic postural stability in hemiplegic patients. Design: A cross sectional assessment of hemiplegic subjects with and without an AFO. Setting: Outpatient department of a rehabilitation hospital. Patients: A convenience sample of 24 subjects who had been prescribed an anterior AFO. Outcome Measures: Postural sway index and postural symmetry (body weight distribution through the affected leg) when standing were measured as static postural stability. Maximal balance range in anterior-posterior and lateral directions and the affected leg's weight bearing after weight shift to affected side were measured as dynamic postural stability. Results: When wearing the anterior AFO, there was no significant difference and small effect size ( r < 0.3) in postural sway index ( p = .35), postural symmetry ( p = .21), and maximal balance range in anterior-posterior direction ( p = .46). There was a significant improvement and large effect size ( r > 0.5) in lateral weight shifting ( p < .01) and weight bearing through the affected leg after weight shifted to the affected side ( p < .01). Conclusions: The significant effects of the anterior AFO in long-term hemiplegic patients were on lateral weight shifting and weight bearing through affected leg after weight shifted to the affected side. Postural sway, postural symmetry, and anterior-posterior weight shifting were not significantly affected.