Postural stability in stroke patients: Vectorial expression of asymmetry, sway activity and relative sequence of reactive forces

  • J. Mizrahi
  • P. Solzi
  • H. Ring
  • R. Nisell
Biomechanics

Abstract

Bilateral force measurements on the supporting limbs in postural sway while standing still were made to evaluate post-cerebral-vascular accident (CVA) patients during rehabilitation. Normal subjects of the same age group were tested as controls. From the force tracings obtained, three oscillation frequencies were identified, with orders of magnitudes of 7, 1 and 0·1 Hz, respectively, of which the middle frequency, i.e. that corresponding to 1 Hz, was selected for subsequent processing and analysis. These included the determination of relative sequence of the force vectors on both feet and evaluation of timings and amplitudes of the waveforms. Weight-bearing imbalance was defined in the vertical direction to express the difference between the average forces supported by each of the legs. In the horizontal plane, two parameters were defined: sway total activity (SA), to represent the vector summation of the absolute values of the horizontal force components acting on both legs; and asymmetry (ASYM) to express the difference in activities between the two legs. The results presented disclose the reactive force patterns acting on each of the legs of post-CVA hemiplegic individuals, in comparison with normal individuals. Although these forces were shown to act synchronously on both legs, they appeared to be asymmetrical in nature, with a typical vectorial pattern for every individual, which generally differed from that of normal subjects. Sway activity was found to be significantly higher in hemiplegics compared with the normal controls.

Keywords

Asymmetry Postural stability Reactive forces Sway activity 

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References

  1. Arcan, M., Brull, M. A., Najenson, T. andSolzi, P. (1977) FGP assessment of postural disorders during the process of rehabilitation.Scand. J. Rehab. Med.,9, 165–168.Google Scholar
  2. Bizzo, G., Guillet, N., Patat, A. andGagey, P. M. (1985) Specifications for building a vertical force platform designed for clinical stabilometry.Med. & Biol. Eng. & Comput.,23, 474–476.Google Scholar
  3. Black, O. F., Wall, C. III andNashner, L. M. (1983) Effects of visual and support surface orientation references upon postural control in vestibular deficient subjects.Acta Otolaryngol.,95, 199–210.Google Scholar
  4. Bles, W. andDeWit, G. (1976) Study of the effects of optic stimuli on standing.Agressologie,17C, 1–5.Google Scholar
  5. Dichgans, J., Mauritz, K. H., Allum, J. H. J. andBrandt, Th. (1976) Postural sway in normals and atactic patients: analysis of the stabilizing and destabilizing effects of vision.Ibid.,17C, 15–24.Google Scholar
  6. Dietz, V., Mauritz, K. H. andDichgans, J. (1980) Body oscillations in balancing due to segmental stretch reflex activity.Exp. Brain Res.,40, 89–95.CrossRefGoogle Scholar
  7. Era, P. andHeikkinen, E. (1985) Postural sway during standing and unexpected disturbance of balance in random samples of men of different ages.J. Gerontology,40, 287–295.Google Scholar
  8. Gantchev, G. andPopov, V. (1973) Quantitative evaluation of induced body oscillations in man.Agressologie,14C, 91–94.Google Scholar
  9. Gueguen, G. andLeroux, J. (1973) Identification d'un modele representant les deplacements du centre de gravite de l'homme.Agressologie,14C, 73–77.Google Scholar
  10. Gurfinkel, E. V. (1973) Physical foundations of oscillography.Ibid.,14C, 9–13.Google Scholar
  11. Harris, G. F., Knox, T. A., Larson, S. J., Sances, A. andMillar, E. A. (1982) A method for the display of balance platform center of pressure data.J. Biomech. 15, 741–745.CrossRefGoogle Scholar
  12. Hashizume, K., Ito, H., Marruyama, H., Saito, H. andIshikawa, M. (1986) Age-related changes of stability in standing posture.Jpn. J. Geriat.,23, 85–92.Google Scholar
  13. Herman, R. andMacEwen, G. D. (1980) Idiopathic scoliosis: a visuo-vestibular disorder of the central nervous system? InSixth Symposium on Scoliosis.Zorab, P. A. (Ed.), Academic Press, New York, 61–69.Google Scholar
  14. Hirashawa, Y. (1973) Study of human standing ability.Agressologie,14C, 37–43.Google Scholar
  15. Hlavacka, F. andLitvinenkova, V. (1973) First derivative of the shabilogram and posture control in visual feedback conditions in man.Ibid.,14C, 45–49.Google Scholar
  16. Hufschmidt, A., Dichgans, J., Mauritz, K. H. andHufschmidt, M. (1980) Some methods and parameters of body sway quantification and their neurological applications.Arch. Psychiat. Nervenkr.,228, 135–150.CrossRefGoogle Scholar
  17. Kapteyn, T. S. (1973) Afterthought about the physics and mechanics of the postural sway.Agressologie,14C, 27–35.Google Scholar
  18. Kapteyn, T. S., Bles, W., Njiokiktjien, Ch. J., Kodde, L., Massen, C. H. andMol, J. M. F. (1983) Stahdardization in platform stabilometry being a part of posturography.Ibid.,24C, 321–326.Google Scholar
  19. Kataoka, J., Sakamoto, K., Hara, T. andHayami, A. (1981) Principal component analysis of spontaneous physical movements in sustained standing posture of children.J. Human Ergol.,10, 61–71.Google Scholar
  20. Kirby, R. L., Price, N. A. andMacLeod, D. A. (1987) The influence of foot position on standing balance.J. Biomech,20, 423–427.CrossRefGoogle Scholar
  21. Kodde, L., Caber, H. B., Mol, J. M. F. andMassen, C. H. (1982) An application of mathematical models in posturography.J. Biomed. Eng.,4, 44–48.Google Scholar
  22. Koozekanani, S. H., Stockwell, C. W., McGhee, R. B. andFiroozmand, F. (1980) On the role of dynamic models in quantitative posturography.IEEE Trans.,BME-27, 605–609.Google Scholar
  23. Lakes, R. S., Korttila, K., Eltoft, D., Derose, A. andGhoneim, M. (1981) Instrumented force platform for postural sway studies.Ibid.,BME-28, 725–729.Google Scholar
  24. Lee, D. N. andLishman, J. R. (1975) Visual proprioceptive control of stance.J. Human Movement Studies,1, 87–95.MATHGoogle Scholar
  25. Lestienne, F., Soechting, J. andBerthoz, A. (1977) Postural readjustments induced by linear motion of visual scenes.Exp. Brain Res.,28, 363–384.CrossRefGoogle Scholar
  26. Mauritz, K. H., Dichgans, J. andHufschmidt, A. (1979) Quantitative analysis of stance in late cortical cerebellar atrophy of the anterior lobe and other forms of cerebellar ataxia.Brain,102, 461–468.Google Scholar
  27. Mizrahi, J., Najenson, T. andNissel, R. (1985) Asymmetry and total activity analysis of postural sway motion in cerebral vascular accident patients. Proc. 14th Int. Conf. on Med. and Biol. Eng. Espoo, Finland.Med. & Biol. Eng. & Comput.,23, Suppl., Part 1, 418–419.Google Scholar
  28. Nashner, L. M. (1976) Adapting reflexes controlling the human posture.Exp. Brain Res.,26, 59–72.CrossRefGoogle Scholar
  29. Nashner, L. M., Black, O. F. andWall, C. III (1981) Adaptation to altered support and visual conditions during stance: patients with vestibular deficits.J. Neurosci,2, 536–544.Google Scholar
  30. Nayak, V. S. L., Gabell, A., Simons, M. A. andIsaacs, B. (1982) Measurement of gait and balance in the elderly.J. Am. Geriatrics Soc.,30, 516–520.Google Scholar
  31. Paulus, W. M., Straube, A. andBrandt, Th. (1984) Visual stabilization of posture.Brain,107, 1143–1163.Google Scholar
  32. Pollak, V. A. andWyss, U. P. (1983) A simple and inexpensive technique for the measurement of head sway.J. Biomech.,16, 349–350.CrossRefGoogle Scholar
  33. Seidel, H. andBrauer, D. (1979) Effects of visual information, conscious control and low-frequency whole-body vibration on postural sway.Agressologie,20C, 189–190.Google Scholar
  34. Seliktar, R., Susak, Z., Najenson, T. andSolzi, P. (1978) Dynamic features of standing and their correlation with neurological disorders.Scand. J. Rehab. Med.,10, 59–64.Google Scholar
  35. Shimba, T. (1983) Ground reaction forces during human standing.Eng. in Med.,12, 177–182.Google Scholar
  36. Shimba, T. (1984) An estimation of center of gravity from force platform data.J. Biomech.,17, 53–60.CrossRefGoogle Scholar
  37. Smith, J. W. (1957) The forces operating at the human ankle joint during standing.J. Anat. (London),91, 545–564.Google Scholar
  38. Snijders, C. J. andVerduin, M. (1973) Stabilograph, an accurate instrument for sciences interested in postural equilibrium.Agressologie,14C, 15–20.Google Scholar
  39. Soames, R. W. andAtha, J. (1980) The validity of physique-based inverted pendulum models of postural sway behaviour.Ann. Human Biol.,7, 145–153.CrossRefGoogle Scholar
  40. Soechting, J. F. andBerthoz, A. (1979) Dynamic role of vision in the control of posture in man.Exp. Brain Res.,36, 551–561.CrossRefGoogle Scholar
  41. Stribley, R. F., Albers, J. W., Tourtellotte, W. W. andCockrell, J. L. (1974) A quantitative study of stance in normal subjects.Arch. Phys. Med. Rehab.,55, 74–80.Google Scholar
  42. Taguchi, K. (1978) Spectral analysis of the movement of the center of gravity in vertiginous and ataxic patients.Agressologie,19B, 69–72.Google Scholar
  43. Thomas, D. P. andWhitney, R. J. (1959) Postural movements during normal standing in man.J. Anat. (London),93, 524–539.Google Scholar
  44. Tokita, T., Miyata, H., Matsuoka, T., Taguchi, T. andShimada, R. (1975) Correlation analysis of the body sway in standing posture.Agressologie,17B, 7–14.Google Scholar
  45. Valk-Fai, T. (1973) Analysis of the dynamical behaviour of the body whilst ‘standing still’.Ibid.,14C, 21–25.Google Scholar
  46. Vidal, P. P., Berthoz, A. andMillanvoye, M. (1982) Difference between eye closure and visual stabilization in the control of posture in man.Avlation, Space & Environ. Med.,53(2), 166–170.Google Scholar
  47. Walsh, E. G. (1973) Standing man, slow rhythmic tilt, importance of vision.Agressologie,14C, 79–85.Google Scholar
  48. Yamamoto, T. (1979a) Changes in postural sway related to fatigue.J. Physical Fitness Jpn.,28, 18–24.Google Scholar
  49. Yamomoto, T. (1979b) Changes in postural sway related to age.Ibid.,28, 249–256.Google Scholar

Copyright information

© IFMBE 1989

Authors and Affiliations

  • J. Mizrahi
    • 1
    • 2
  • P. Solzi
    • 3
  • H. Ring
    • 3
  • R. Nisell
    • 4
  1. 1.Department of Biomedical EngineeringTechnion-Israel Institute of TechnologyHaifaIsrael
  2. 2.The Julius Silver Institute of Biomedical EngineeringTechnion-Israel Institute of TechnologyHaifaIsrael
  3. 3.Loewenstein Rehabilitation HospitalRaananaIsrael
  4. 4.Karolinska InstituteStockholmSweden

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