Objective: To investigate if measuring ground reaction force after a sideways push at the hips gives a measure of standing balance in stroke subjects.
Methods: Fifteen control subjects and 13 right hemiparetic subjects who were able to stand independently stood with their feet on a single forceplate. Horizontal sideways pushes of 3% body weight were delivered to each side of the pelvis with the subjects held firmly in a semi-rigid belt. Measurements were made of lateral pelvic displacement (sway) and the lateral sheer component of ground reaction force (GRF).
Results: Right hemiparetic subjects showed significantly greater sway after a sideways push (p < 0.01) and later onset of GRF (p < 0.01) when pushed to their weak side compared with control subjects. There was also a positive correlation between sway after a sideways push and the onset latency of GRF in both strokes (0.41) and controls (0.61). The hemiparetic subjects swayed more (p < 0.01) when pushed to their weak side compared with their stronger side and their GRF latency was longer, but this latter measurement failed to reach statistical significance. No difference was seen between sides in sway or GRF latency in controls.
Conclusions: The latency of GRF onset after a push at the hips in controls and in stroke subjects is related to sway and both measurements increase after a stroke. This test offers a method of measuring balance after a stroke, and serial testing of an individual after a stroke may prove a useful measure of an individual's recovery of balance.
Get full access to this article
View all access options for this article.
References
1.
Lee WA, Derning L, Sahgal V. Quantitative and clinical measures of static standing balance in hemiparetic and normal subjects. Phys Ther1988; 68: 970–976.
2.
Wing AM, Barton J, Turton A, Howick I. Regulation of lateral position of body centre of mass in standing balance. Physiother Theor Pract1992; 8: 131–135.
3.
Dettman M, Linder M, Sepic S. Relationships among walking performance, postural stability and functional assessments of the hemiplegic patient. Am J Phys Med1987; 66: 77–90.
4.
Tutuarima JA, Van der Meulen JHP, de Haan RJ, Van Straten A, Limberg M. Risk factors for falls of hospitalised stroke patients. Stroke 1997; 28: 297–301.
5.
Sackley C. The relationship between weight-bearing asymmetry after stroke, motor function and activities of daily living. Physiother Theor Pract1990; 6: 179–185.
6.
Carrera DJ, Sharpe MH, Pearce A, Frick RA. The reliability of postural sway measures using the 3D space tracker. Clin Biomech1996; 11: 361–363.
7.
Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol1990; 45: 192–197.
8.
Horak F, Henry S, Shumway Cook A. Postural perturbation, new insights for the treatment of balance disorders. Phys Ther1997; 77: 517–533.
9.
Badke MB, Duncan P. Patterns of rapid motor responses during postural adjustments when standing in healthy subjects and hemiplegic patients. Phys Ther1983; 63: 13–20.
10.
Wing AM, Goodrich S, Virji-Babul N, Jenner JR, Clapp S. The evaluation of balance in hemiparetic stroke subjects using lateral forces applied to the hip. Arch Phys Med Rehabil1993; 74: 292–229.
11.
McClenaghan BA, Williams HG, Dickerson J, Dowda M, Thombs L, Eleazer P. Spectral characteristics of aging postural control. Gait Posture1995; 3: 123–131.
12.
Dickstein R, Nissan M, Pillar T, Scheer D. Foot ground pressure patterns of standing hemiplegic patients: major characteristics and patterns of improvement. Phys Ther1984; 64: 19–23.
13.
Diller L, Weinberg I. Evidence of accident prone behaviour in hemiplegics. Arch Phys Med Rehabil1970; 6: 358–362.
14.
Wing AM, Clapp S, Burgess-Limerick R. Standing stability in the frontal plane determined by lateral forces applied to the hip. Gait Posture1995; 3: 38–42.
15.
Wade DT, Langton Hewer R. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry1987; 50: 177–182.
16.
Weiner DK, Bongiorni DR, Studenski SA, Duncan PW, Kochersberger GG. Does functional reach improve with rehabilitation?Arch Phys Med Rehabil1993; 74: 796–800.
17.
Jenner JR, Kirker S, Simpson D, Wing AM. Sideways balance after stroke – a serial study of hip abductors and adductors. Eur J Neurol1996; 3: 127-127.
