Quantitative Static and Dynamic Assessment of Balance Control in Stroke Patients

Summary

Presented here is a quantitative, clinical balance assessment method suitable for stroke patients with balance disorders.

Abstract

In patients with stroke, damage to the central nervous system (CNS) can affect the postural stability and increase the risk of falling. Therefore, accurately assessing the balance is important to understand the type, extent, and causes of balance deficit, and to identify individualized interventions. Clinical assessment methods for balance function can be broadly divided into observation, scale assessment, and balance instrument testing. Here, a clinical protocol is presented for static and dynamic balance assessment in stroke patients, which includes three semiquantitative balance function scale assessments (i.e., Berg Balance Scale, Timed Up and Go Test, and Fugl-Meyer Assessment) and three quantitative instrumental balance evaluation (i.e., Stability Assessment Module, Proprioceptive Assessment Module, and Limit of Stability Module). It is recommended that clinicians consider the use of both classic clinical balance scales and instrumental balance measurements when assessing stroke patients to improve the accuracy of assessments, leading to a better individualized treatment plan.

Introduction

The human body can maintain posture stability under various conditions, including internal and external disturbances¹. Balance relies on sensory input, integration of the central nervous system (CNS), and motor control². In patients with stroke, damage to the CNS can affect the ability to maintain balance³. Postural instability is an important risk factor for falls⁴. Approximately 70% of patients experience a fall in the first year after stroke, often with serious consequences, such as hip fracture in elderly patients^5,6. Moreover, previous studies have shown that postural sway and increased motor response time to visual stimuli are associated with an increased fall risk^7,8. Because strokes have a substantial impact on mobility, accurate qualitative and quantitative balance assessment is important for understanding the type, extent, cause of balance deficit, as well as guidance for individualized interventions and appropriate gait aids⁹.

Clinical assessment methods for balance can be broadly divided into observation, scale assessment, and balance instrument testing. Observation methods (e.g., the Romberg test¹⁰) are only used as a rough screening for patients with balance dysfunction due to their strong subjectivity. Many balance function scales are commonly used in clinical practice because of their ease-of-use, economy, and relative quantification. These include the Tinetti scale¹¹, Berg Balance Scale (BBS)¹², Fugl-Meyer Assessment (FMA)¹³, and Timed Up and Go (TUG) test¹². These clinical tests are not suitable for determining the fall risk in patients with significant balance disorders, because they are subjective assessments and often are not able to substantiate the self-reported balance problems experienced by individuals with mild-to-moderate balance problems¹⁴. Balance instrument testing, a posturography technique, is a useful tool to quantitatively measure the static and dynamic balance function and require balance evaluation systems, such as a force tilting board with pressure sensors, computers, monitors, balance control panels, and professional balance analysis software. These approaches can assess the degree, type, or cause of the balance damage simultaneously by accurately measuring the center of gravity (COG) and postural sway, thereby precisely and objectively reflecting the patient’s balance function. Balance instrument testing can detect subtle differences or damages that the clinical scales cannot. This can be used to overcome the ceiling effect of the scale assessment. With the increasing application of posturography techniques and popularization of computers, it is necessary to promote objective/quantitative balance assessment into clinical practice.

This article describes a clinical balance assessment method that includes standard clinical balance scales and three-module instrument objective balance assessment for stroke patients with balance disorders. A comparison of the results of the clinical assessment scales versus the instrumental balance assessment, is presented to show the advantages of instrumental balance assessment, especially for stroke patients with mild balance disorders. This protocol can help health professionals achieve accurate evaluation to guide clinical treatments. The representative posturography instrument (see Table of Materials) used in this protocol has been validated for dynamic assessment and statistic assessment in previous studies^15,16,17. The system, which is composed of a screen monitor and a tilting board where the patients stand, can be used for evaluating the visual, auditory, and proprioceptive feedback of the patients.

Protocol

The clinical project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University and has been registered at the China Clinical Trial Registration Center (No. ChiCTR1900021291) with the title “The mechanism and effect of Pro-kin system training on static and dynamic balance”. 1. Participant recruitment Include patients with brain hemorrhage or infarction confirmed by magnetic resonance imaging (MRI) or computerized tomo…

Representative Results

Results from nine stroke patients with balance deficits are shown. The average age of the nine patients recruited in our study was 52.7 years; all of them were male. Four suffered from right hemiplegia. The average FIM-LE, TUG, and BBS values were 23.9 points, 31.8 s, and 46.8 points, respectively. The other demographic characteristics (BMI, stroke type, and onset time) are shown in Table 2. Each item score and the total scores of the BBS assessment of each of the nine stroke patients are shown in <stron…

Discussion

Described is a clinical protocol for static and dynamic balance assessment in stroke patients that includes three semiquantitative balance function scale assessments (BBS, TUG, and FMA-LE) and three models of quantitative instrumental balance evaluation (Stability Assessment, Proprioceptive Assessment, and Limit of Stability). The design of this protocol was based on five main points.

First, the BBS is a 14-function-task on a 5-point scale that semiquantitatively assesses static and dynamic ba…

Materials

Electric Lifting Bed	Guangzhou Yikang Medical Equipment Industrial Co., Ltd	YK-8000	Required for Fugl-Meyer assessment
Percussion hammer	ICARE-MEDICAL Co., Ltd.	CRT-104	Required for Fugl-Meyer assessment
Prokin Balance System	Tecnobody .S.r.l, Italy	ProKin 252	Balance evaluation and training system
Ruler	M&G Chenguang Stationery Co.,Ltd.	AHT99112	Required for Berg Balance Scale assessment
Stopwatch	95,Shenzhen Junsd Industrial Co., Ltd have been striven all the years de	JS-306	Required for Berg Balance Scale assessment