Role of Spasticity Severity on the Balance of Post-stroke Patients

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.

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Role of spasticity severity on the balance of post-stroke patients (Preprint)

10.2196/preprints.33237 ◽

2021 ◽

Author(s):

Ashraf Mahmoudzadeh ◽

Noureddin Nakhostin Ansari ◽

Soofia Naghdi ◽

Ehsan Ghasemi ◽

Brandon S Shaw ◽

...

Keyword(s):

Range Of Motion ◽

Ankle Joint ◽

Postural Sway ◽

Dynamic Balance ◽

Ankle Dorsiflexion ◽

Plantar Flexor ◽

Stroke Patients ◽

Timed Up And Go ◽

Balance Confidence ◽

Post Stroke

BACKGROUND Lower limb spasticity, as is common following a cerebrovascular attack (CVA) or stroke, can affect the balance and gait of patients. This then not only affects independence, and quality of life, but also increases the risk for other concerns, such as falling and an increased sedentariness, which could further affect health outcomes. OBJECTIVE We aimed to evaluate the effect of ankle plantar flexor spasticity severity on balance and to determine the relationship between the spasticity severity with ankle proprioception, passive range of motion (ROM), and balance confidence in post-stroke patients. METHODS Twenty-eight post-stroke patients were divided into two groups based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS) as a 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 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. RESULTS No significant (p>0.05) differences were found between the LSG and HSG in terms of balance confidence, dynamic balance, and ankle dorsiflexion ROM. In addition, postural sway in the open and closed eye conditions was not significantly different in both the LSG and HSG for both the less affected and affected limbs. Similarly, posturography indicators in the open and closed eye conditions were not significantly different in both the LSG and HSG for both the less affected and affected limbs. However, ankle joint proprioception in terms of repositioning error angle was significantly (p≤0.05) better in the LSG compared to the HSG (p=0.01). There was also a significant relationship between TUG scores and balance confidence in the HSG(r=-0.55, p=0.04) CONCLUSIONS Our data suggests that several aspects of balance needs to be considered in the assessment and rehabilitation of post-stroke patients and there is a need to monitor entire patterns of activities to support wider engagement in rehabilitation activities. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16045

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Effect of Plantar Flexor and Dorsiflexor Fatigue on Unilateral Postural Control

Journal of Applied Biomechanics ◽

10.1123/jab.9.3.191 ◽

1993 ◽

Vol 9 (3) ◽

pp. 191-201 ◽

Cited By ~ 66

Author(s):

Thomas M. Lundin ◽

Jon W. Feuerbach ◽

Mark D. Grabiner

Keyword(s):

Ankle Joint ◽

Postural Sway ◽

Plantar Flexor ◽

Plantar Flexors ◽

Joint Injury ◽

Balance System ◽

Fatigue Protocol ◽

Before And After ◽

Ankle Muscle ◽

Male Subjects

The purpose of this study was to determine the effect of plantar flexor and dorsiflexor fatigue on postural sway amplitude during unilateral, or one-legged, stance. It was hypothesized that plantar flexor and dorsiflexor fatigue would increase unilateral postural sway amplitude. Eight uninjured male subjects participated in pre- and postfatigue unilateral stability tests. Selected parameters describing medial-lateral (ML) and anterior-posterior (AP) postural sway were measured on a Chattecx Balance System before and after an isokinetic fatigue protocol. The fatigue protocol resulted in a significant increase in ML postural sway amplitude (p< 0.05) and an increase in AP sway amplitude (p= 0.065). Previously, links have been established between increased postural sway amplitude and ankle joint injury. Thus, fatigue of the plantar flexors and dorsiflexors, which increased postural sway amplitude, may render the ankle joint susceptible to injury. Induced ankle muscle fatigue may represent a valid paradigm to study the causes of traumatic ankle joint injury.

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Investigation of Balance in Old People Residing in Nursing Homes Using Clinical Assessments

Function and Disability Journal ◽

10.32598/fdj.3.137.1 ◽

2020 ◽

Vol 3 (1) ◽

pp. 11-16

Author(s):

Sogol Zeinali ◽

◽

Zahra Olyaei ◽

Benyamin Kor ◽

Maryam Binesh ◽

...

Keyword(s):

Nursing Homes ◽

Postural Sway ◽

Age Groups ◽

Clinical Test ◽

Old People ◽

Timed Up And Go ◽

Cross Sectional ◽

Clinical Assessments ◽

Eyes Closed ◽

Eyes Open

Background and Objectives: Balance problems are the main cause of falls and fall-related complications in the elderly. The objective of this study was to investigate the balance in old people residing in nursing homes using clinical assessments. Methods: A total of 54 people participated in this cross-sectional study. Timed Up and Go (TUG) was used to assess balance regarding mobility impairments. The modified Clinical Test Of Sensory Interaction on Balance (CTSIB) was also used to assess balance regarding sensory problems. This test was used in 4 conditions: standing with eyes open on a firm surface, standing with eyes closed on a firm surface, standing with eyes open on a compliant foam, and standing with eyes closed on a compliant foam. Data analysis was done by SPSS V. 18 software. Results: The mean time for the completion of TUG was significantly higher than standard scores in all age groups (P<0.05). Postural sway during standing with eyes closed on the ground, eyes open and eyes closed on the foam was more than standing with eyes open on the ground (P<0.001). Postural sway in standing with eyes closed on the foam was more in comparison with standing with eyes closed on the ground and eyes open on the foam (P<0.001). Conclusion: Elderly people living in nursing homes had poorer motor skills to maintain balance. They also showed greater dependence on visual and sensory systems to maintain balance.

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The measurable parameters of balance trainings in case of young healthy adults: Improved balance confidence or better postural stability? A pilot study

Developments in Health Sciences ◽

10.1556/2066.2021.00037 ◽

2021 ◽

Author(s):

G. Posa ◽

D. Farkasinszky ◽

T. Margithazi ◽

E. Nagy

Keyword(s):

Pilot Study ◽

Postural Sway ◽

Force Plate ◽

Balance Training ◽

Balance Confidence ◽

Eyes Closed ◽

Healthy Female ◽

Eyes Open ◽

Support Surfaces ◽

Base Of Support

AbstractPurposeThe objective of this pilot study was to compare the effects of two parallel balance trainings on postural sway and balance confidence. The study was performed in different contexts with stable vs. unstable base of support and balance confidence was measured with a scale modified for young adults with higher functional level.Materials/methodsTwenty healthy female physiotherapist students volunteered for the study and took part in a six-week balance training intervention. They were randomly assigned to two groups training on different support surfaces. Postural sway was recorded under various conditions: on different surfaces (firm, foam) and with different visual conditions (eyes open (EO), eyes closed (EC)). Modified Activities-specific Balance Confidence (mABC) scale was self-evaluated.ResultsBoth types of training caused a significant improvement in the mABC scores. The sway path increased after the training in the less challenging balance situations. We found a tendency of decreasing sway path only in the more challenging balance situations, that is standing on foam mounted on force plate with EC.ConclusionsConsidering the improved balance confidence in the case of both groups, we suggest that an increase in sway path after balance training may be the behavioural sign of the higher confidence in the less challenging balance situations.

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Altering Visual Feedback Conditions Impacts Postural Sway Performance in Children After Controlling for Body Mass Index and Habitual Physical Activity

Journal of Motor Learning and Development ◽

10.1123/jmld.2016-0039 ◽

2017 ◽

Vol 5 (2) ◽

pp. 267-279 ◽

Cited By ~ 1

Author(s):

Michael Duncan ◽

Elizabeth Bryant ◽

Mike Price ◽

Samuel Oxford ◽

Emma Eyre ◽

...

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Body Mass ◽

Visual Feedback ◽

Postural Sway ◽

Habitual Physical Activity ◽

Eyes Closed ◽

Computerized Posturography ◽

Eyes Open ◽

Anterior Posterior

This study examined postural sway in children in eyes open (EO) and eyes closed (EC) conditions, controlling for body mass index (BMI) and physical activity (PA). Sixty two children (aged 8–11years) underwent sway assessment using computerized posturography from which 95% ellipse sway area, anterior/posterior (AP) sway, medial/lateral (ML) sway displacement and sway velocity were assessed. Six trials were performed alternatively in EO and EC. BMI (kg/m2) was determined from height and mass. PA was determined using sealed pedometry. AP amplitude (p = .038), ML amplitude (p = .001), 95% ellipse (p = .0001), and sway velocity (p = .012) were higher in EC compared with EO conditions. BMI and PA were not significant as covariates. None of the sway variables were significantly related to PA. However, sway velocity during EO (p = .0001) and EC (p = .0001) was significantly related to BMI. These results indicate that sway is poorer when vision is removed, that BMI influences sway velocity, but that pedometer-assessed PA was not associated with postural sway.

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Reliability of Force-Platform Measures of Postural Sway and Expertise-Related Differences

Journal of Sport Rehabilitation ◽

10.1123/jsr.20.4.442 ◽

2011 ◽

Vol 20 (4) ◽

pp. 442-456 ◽

Cited By ~ 13

Author(s):

Zohreh Meshkati ◽

Mehdi Namazizadeh ◽

Mahyar Salavati ◽

Masood Mazaheri

Keyword(s):

Outcome Measures ◽

Postural Sway ◽

Center Of Pressure ◽

Intraclass Correlation ◽

Specific Property ◽

Force Platform ◽

Quiet Standing ◽

Eyes Closed ◽

Before And After ◽

Eyes Open

Context:Although reliability is a population-specific property, few studies have investigated the measurement error associated with force-platform parameters in athletic populations.Objective:To investigate the skill-related differences between athletes and nonathletes in reliability of center-of-pressure (COP) summary measures under eyes-open (EO) and eyes-closed (EC) conditions.Design:Test–retest reliability study.Setting:COP was recorded during double-leg quiet standing on a Kistler force platform before and after a fatiguing treadmill exercise, with EO and EC.Participants:31 male participants including 15 athletes practiced in karate and 16 nonathletes.Main Outcome Measures:Standard deviation (SD) of amplitude, phase-plane portrait, SD of velocity, mean total velocity, and area were calculated from 30-s COP data. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation (CV) were used as estimates of reliability and precision.Results:Higher ICCs were found for COP measures in the athlete (compared with the nonathlete) group, postfatigued (compared with prefatigued) condition, and EC (compared with EO) tests. CVs smaller than 15% were obtained for most of the COP measures. SD of velocity in the anteroposterior direction showed the highest reliability in most conditions.Conclusions:Tests with EC and to a lesser extent tests performed in the athlete group and in the postfatigued condition showed better reliability.

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Control of Stance and Developmental Coordination Disorder: The Role of Visual Information

Adapted Physical Activity Quarterly ◽

10.1123/apaq.21.1.19 ◽

2004 ◽

Vol 21 (1) ◽

pp. 19-33 ◽

Cited By ~ 19

Author(s):

Eryk P. Przysucha ◽

M. Jane Taylor

Keyword(s):

Visual Information ◽

Path Length ◽

Developmental Coordination Disorder ◽

Postural Sway ◽

Quiet Standing ◽

Eyes Closed ◽

Total Path Length ◽

Eyes Open ◽

Stability Limits ◽

Coordination Disorder

The purpose of this study was to compare the postural sway profiles of 20 boys with and without Developmental Coordination Disorder (DCD) on two conditions of a quiet standing task: eyes open and eyes closed. Anterior-posterior (AP) sway, medio-lateral sway (LAT), area of sway, total path length, and Romberg’s quotient were analyzed. When visual information was available, there was no difference between groups in LAT sway or path length. However, boys with DCD demonstrated more AP sway (p < .01) and greater area of sway (p < .03), which resulted in pronounced excursions closer to their stability limits. Analysis of Romberg’s quotient indicated that boys with DCD did not over-rely on visual information.

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Impact of Single Bout of Physical Exercise on Adolescents’ Strength and Balance Abilities

Baltic Journal of Sport and Health Sciences ◽

10.33607/bjshs.v1i96.75 ◽

2018 ◽

Vol 1 (96) ◽

Author(s):

Lina Kreivėnaitė ◽

Vytautas Streckis ◽

Sandra Raizgytė ◽

Asta Lileikienė

Keyword(s):

Physical Exercise ◽

High Intensity ◽

Postural Sway ◽

High Intensity Exercise ◽

Body Balance ◽

Low Intensity ◽

Eyes Closed ◽

Single Bout ◽

Eyes Open ◽

The Impact

Background. There is evidence of physical exercise effect on the adolescents’ balance and strength; however it is not known how aforementioned variables respond to physical exercise with different loads and intensities. Therefore, the aim of the study was to assess the impact of single bout of physical exercise of different intensity on adolescents’ body balance and muscular strength.Methods. Thirty healthy, physically active 11–13-year-old adolescents were randomly allocated to one of the two groups. Both groups performed single bout of physical exercise of high- or low-intensity climbing up and down-stairs. Postural sway and maximum voluntary contractions (MVC) were assessed before and after physical exercise. Results. No statistically significant impact of low or high intensity exercise was found at adolescents’ MVC. High intensity exercise influenced bigger postural sway with eyes closed compared to eyes open ( p < .05). After high-intensity exercise there was a significantly greater postural sway with eyes closed than with eyes open (p < .05). Conclusions. High and low intensity physical exercise had no impact on the adolescents’ maximum voluntary contraction, whereas high intensity exercise deteriorated body balance with eyes closed.Keywords: adolescence, physical exercise, MVC, balance

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Effect of a “T-Band” Kick Training Protocol on Postural Sway

Journal of Sport Rehabilitation ◽

10.1123/jsr.7.2.122 ◽

1998 ◽

Vol 7 (2) ◽

pp. 122-127 ◽

Cited By ~ 4

Author(s):

Andrew G. Baker ◽

William G. Webright ◽

David H. Perrin

Keyword(s):

Postural Sway ◽

Stability Index ◽

Control Group ◽

Eyes Closed ◽

Before And After ◽

Proprioceptive Training ◽

Eyes Open ◽

Potential Benefits ◽

Experimental Group ◽

Training Protocol

The purpose of this study was to examine the effects of a resistive tubing kick training protocol on postural sway in uninjured collegiate wrestlers. An experimental group (n= 10) performed a progressive resistive tubing kick training protocol three times per week for 6 weeks. A control group (n= 9) performed no resistive tubing training during the 6 weeks. Postural sway (stability index) was assessed before and after the 6-week training period. ANOVAs demonstrated no significant interactions, although significant main effects were found for group and eye condition. The experimental group demonstrated less postural sway than the control group regardless of training, and postural sway was greater with the eyes closed than with the eyes open. Resistive tubing kick training does not significantly improve postural sway in healthy collegiate wrestlers. Further research should examine the potential benefits of proprioceptive training using a greater intensity of training and/or using subjects who have a greater potential for improvement.

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Comparison of Ankle Proprioception Between Blind and Healthy Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00156 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0015

Author(s):

Muhammet Özer ◽

Haydar Kaynak ◽

Aziz Atik ◽

Mehtap Kaçmaz Şilil ◽

Muammer Altun ◽

...

Keyword(s):

Plantar Flexion ◽

Position Sense ◽

Joint Position Sense ◽

Athletic Department ◽

Eyes Closed ◽

Eyes Open ◽

Blind Persons ◽

Ankle Proprioception ◽

Blind Individuals

Objectives: The positive effect of the visual sensation on the proprioceptive quality is well known. Although other senses of the congenital blind individuals have been proven to be increased more than healthy ones, there has been no data about the proprioceptive quality of congenital blind persons. The aim of this study is to determine the quality of ankle proprioception in congenital blind athletes. Methods: 15 congenital blind athletes (10 males and 5 females) with a mean age of 24 ± 2.9 (ranging from 20 to 29), and 15 healthy athletes (10 males and 5 females) with a mean age of 24.6 ± 3.05 (ranging from 20 to 29), from the same athletic department, were included in the study. Proprioception was evaluated by using the technique of joint position sense, and absolut errors during the reproduction of six target angles (plantar flexion 100, dorsiflexion 50, inversion 100 and 200, eversion 100 and 200) were detected in dominant and nondominant ankles of both groups. Athletes were measured both eyes open and closed. Statistical analysis was done by using Mann-Whitney U and Wilcoxon Signed Ranks tests. Results: When dominant extremities were compared while eyes open, there was only a difference in 50 dorsiflexion measurements statistically in favor of blind ones (p<0.05). When dominant extremities were compared while eyes closed, blind athletes got less wrong in four of the six target angles statistically (p<0.01), when non-dominant extremities were compared while eyes closed, blind athletes got less wrong in all angles statistically (p<0.01). The ankle proprioception of the blind athletes were better then the normal athletes. The ankle propriceptions of the normal athletes further deteriorated when their eyes were closed. Conclusion: We found that the ankle proprioceptions of congenital blind athletes were better than the normal athletes. So additional closed-eyes exercises can help to reach a high proprioceptive level of athletes in a normal season which in terms may decrease accidental traumas.

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