Reha Kongresse 2018


Maximum weight-shifts in sitting in people with stroke are related with trunk control and balance 

E. Wiskerke (Valens)

Impaired sitting balance is common in non-ambulatory persons with stroke (PwS), affecting postural control in different directions. However, studies investigating weight shifts in the diagonal directions are limited. The aim of this cross-sectional study was to measure the maximum voluntary weight shifts (MVWS) in sitting in PwS, compared to healthy controls (HC), and to relate these findings with clinical measures of trunk control and balance in sitting and standing.
14 PwS in the rehabilitation phase and 32 HC were recruited. A force-platform evaluated static weight-bearing and MVWS, by centre of pressure (COP) displacements. Sides were defined as the preferred (PSoWB) and non-preferred side of weight-bearing (NPSoWB). Clinical measures included: Trunk Control Test (TCT), Trunk Impairment Scale (TIS) and Berg Balance Scale (BBS).
COP distance was significantly smaller in all directions in PwS compared to HC (p<0.05). The TCT, TIS and BBS showed moderate to very high correlations with COP distance in the diagonal forward, diagonal backward and lateral directions (range 0.54-0.89). Further results show that PwS with the PSoWB on the non-affected side had significantly greater COP distances in all directions and scored significantly better on clinical measures (p<0.05).
Discussion et conclusions
MVWS in PwS are reduced in comparison to HC, in all directions. Especially the lateral and diagonal directions seem relevant to address further as they are most strongly correlated with clinical measures. The influence of the PSoWB on the clinical outcome after stroke warrants clinical attention as well as future research.
Importance pour la pratique
Commercially available force platforms offer clinicians an objective measurement of sitting balance in PwS, even when patients are severely affected and clinical measurements show a floor-effect. Since the PSoWB is strongly associated with clinical measurements of balance and trunk control, assessing which side PwS prefer seems useful to determine treatment goals. Hereby, the training modalities of force platforms can be used, with the advantage of practicing a leaning task with an external focus.