Recovery of standing balance and functional mobility after stroke

Objective: To examine the extent to which recovery of functional balance and mobility is accompanied by change in a few specific physiologic measures of postural control. Design: Longitudinal prospective study. Setting: Laboratory setting in Ontario. Participants: Twenty-seven volunteers (age, 64.2+/-13.7y) undergoing 4 weeks of rehabilitation after stroke participated. At initial testing, patients were 32.7 +/- 18.4 days poststroke and exhibited a moderate level of motor recovery (lower-extremity and postural control, stages 3-4 on the Chedoke-McMaster Stroke Assessment Impairment Inventory). Interventions: Not applicable. Main Outcome Measures: Three functional measures (Berg Balance Scale, Clinical Outcome Variables Scale, gait speed) were assessed. Three physiologic measures (electromyographic data of hamstrings and soleus muscles bilaterally, postural sway, arm acceleration) were taken while subjects stood quietly on a force platform and while they performed a rapid shoulder flexion movement of the nonparetic upper extremity. Results: After 1 month of rehabilitation, there was an overall significant improvement in all outcome measures (functional, physiologic). However, 10 patients failed to show any improvement in the electromyographic activation of hamstrings muscle on the paretic side in response to the rapid arm movement. These patients compensated by increasing the anticipatory activation of the nonparetic hamstrings. Conclusion: After stroke, patients showed improvement in both physiologic and functional measures of balance and mobility over a 1-month period. We have identified some patients who may be using compensatory strategies to increase function. The factors that may predict those patients who are likely to use compensatory strategies awaits further study.