In Neurorehabilitation and Neural Repair Jolanda Roelofs and Sander Geurts showed that well-recovered persons in the chronic phase after stroke with clinically no (or only very limited) motor impairment of the affected leg may still show substantial problems with standing balance control.They performed a study in 70 persons in the chronic phase after stroke with a wide range of leg motor impairments. To assess standing balance, subjects stood quietly barefoot on two force plates for 30 seconds. In persons with substantial leg motor impairment, the non-affected leg contributed much more to standing balance control than the affected leg. Remarkably, this was also the case for the 21% of well-recovered subjects with hardly any leg motor impairment. Despite an asymmetric contribution of both legs, all persons were able to effectively control their balance during quiet two-legged standing. This result points towards effective compensation by the non-affected leg, which is facilitated by the fact that most subjects bore more weight on their non-affected leg.
The clinical implication of these results is that seemingly well-recovered stroke patients are easily overestimated with regard to their balance capacity, because clinical leg motor scores do not capture the subtle motor control needed for balance. This notion may also be the explanation why patients after a second (bilateral) stroke show a relatively severe decline in their balance capacity, since compensation by the sound side is no longer possible.
Relationships Between Affected-Leg Motor Impairment, Postural Asymmetry, and Impaired Body Sway Control After Unilateral Supratentorial Stroke
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