Stephen L Parsons1,2, Avril Mansfield2,3,4, Elizabeth L Inness2,4, Kara K Patterson1,2,4. 1. a Health and Rehabilitation Sciences , Western University , London , Canada. 2. b Department of Research , Toronto Rehab, University Health Network , Toronto , Canada. 3. c Clinical Evaluative Sciences , Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute , Toronto , Canada. 4. d Department of Physical Therapy , University of Toronto , Toronto , Canada.
Abstract
OBJECTIVES: Stroke rehabilitation best practices recommend interventions to address individual deficits, guided by a comprehensive assessment to identify specific impairments. The relationship of motor impairments to balance has been well investigated, but the role of impaired plantar cutaneous sensation is less understood, despite the fact that 41% of individuals post-stroke have this deficit. The study objectives were to (1) characterize the relationship between plantar sensation and measures of standing balance control and (2) determine the threshold of sensory impairment related to balance impairment post-stroke. METHODS: Monofilament test scores, force plate measures of standing balance control and Berg Balance Scale (BBS) scores were extracted from 52 inpatient rehabilitation charts. Spearman correlations were conducted between sensation and balance measures. Receiver operator characteristic (ROC) analysis was completed to determine the monofilament score that best discriminates between individuals with impaired and unimpaired balance (as defined by variability of center of pressure [COP] in the mediolateral direction). RESULTS: Plantar sensation of the affected foot was correlated with anteroposterior COP variability in standing with eyes closed and BBS scores. ROC analysis determined that a monofilament cut-off of 4.31 log(mg) discriminated individuals with impaired balance with 73% sensitivity and 70% specificity. DISCUSSION: The present results suggest that plantar cutaneous sensation deficits contribute to balance impairment post-stroke. The monofilament cutoff score may help clinicians determine whether impaired plantar cutaneous sensation is a contributing factor to a patient's balance deficits.
OBJECTIVES:Stroke rehabilitation best practices recommend interventions to address individual deficits, guided by a comprehensive assessment to identify specific impairments. The relationship of motor impairments to balance has been well investigated, but the role of impaired plantar cutaneous sensation is less understood, despite the fact that 41% of individuals post-stroke have this deficit. The study objectives were to (1) characterize the relationship between plantar sensation and measures of standing balance control and (2) determine the threshold of sensory impairment related to balance impairment post-stroke. METHODS: Monofilament test scores, force plate measures of standing balance control and Berg Balance Scale (BBS) scores were extracted from 52 inpatient rehabilitation charts. Spearman correlations were conducted between sensation and balance measures. Receiver operator characteristic (ROC) analysis was completed to determine the monofilament score that best discriminates between individuals with impaired and unimpaired balance (as defined by variability of center of pressure [COP] in the mediolateral direction). RESULTS: Plantar sensation of the affected foot was correlated with anteroposterior COP variability in standing with eyes closed and BBS scores. ROC analysis determined that a monofilament cut-off of 4.31 log(mg) discriminated individuals with impaired balance with 73% sensitivity and 70% specificity. DISCUSSION: The present results suggest that plantar cutaneous sensation deficits contribute to balance impairment post-stroke. The monofilament cutoff score may help clinicians determine whether impaired plantar cutaneous sensation is a contributing factor to a patient's balance deficits.