Recovery Patterns of Postural Control in Patients with Subacute Stroke: A Longitudinal Comparison of Supratentorial Versus Infratentorial Lesions Using the Mini-BESTest

Abstract

Background

Patients with mild stroke often regain basic mobility, however, subtle postural control deficits may persist, increasing the risk of falls. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a sensitive measure for detecting such impairments. This study aimed to clarify postural control characteristics and temporal changes by classifying patients with subacute stroke into supratentorial and infratentorial lesion groups.

Methods

In this prospective longitudinal observational study, 38 patients were assessed using the Mini-BESTest at baseline and at 1 month. A three-way mixed-design ANOVA examined lesion location (between-subjects), time, and Mini-BESTest subscales (anticipatory, reactive, sensory orientation, and dynamic gait) (within-subjects). Post-hoc analyses were performed using Shaffer’s modified sequentially rejective Bonferroni procedure.

Results

A significant interaction between lesion location and subscales was observed (F(2.42, 80.73) = 6.21, p = .002, η_p² = .14). The supratentorial group demonstrated significantly lower scores in reactive postural control compared with other subscales (p < .001), and this deficit persisted at 1 month despite overall balance improvements. In contrast, the infratentorial group showed balanced improvements across all subcomponents, with no significant domain-specific deficits. Both groups showed significant improvement over time.

Conclusions

The Mini-BESTest is a sensitive tool for identifying lesion-specific postural control deficits, even in high-functioning patients. Although the supratentorial category encompasses functionally heterogeneous structures (e.g., thalamus and putamen), these findings highlight the importance of using the Mini-BESTest to detect residual impairments in reactive postural control in supratentorial stroke, highlighting the need for targeted interventions, such as reactive balance training, to reduce fall risk.