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Contribution of muscle strength and integration of afferent input to postural instability in persons with stroke.

Marigold DS, Eng JJ, Tokuno CD, Donnelly CA

Graduate Program in Neuroscience, University of British Columbia, and Rehab Research Lab, G.F. Strong Rehab Centre, Vancouver, BC, Canada.

OBJECTIVE: To determine the relationship of muscle strength to postural sway in persons with stroke under standing conditions in which vision and ankle proprioception were manipulated. METHODS: Forty persons with stroke and 40 healthy older adult controls were recruited from the community and underwent balance testing consisting of 6 conditions that manipulate vision and somatosensory information while standing. Postural sway was measured during each condition. In addition, lower extremity joint torques and cutaneous sensation from the plantar surface of the foot were assessed. RESULTS: Postural sway was increased with more challenging standing conditions (i.e., when multiple sensory systems were manipulated) to a greater extent with the group with stroke compared to controls. Muscle strength was only correlated to sway during the most challenging conditions. Furthermore, a greater number of persons with stroke fell during the balance testing compared to controls. CONCLUSIONS: Impairments in re-weighting/integrating afferent information, in addition to muscle weakness, appear to contribute to postural instability and falls in persons with stroke. These findings can be used by clinicians to design effective interventions for improving postural control following stroke.

Published 11 November 2004 in Neurorehabil Neural Repair, 18(4): 222-9.
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