Parsons Stephen L, Mansfield Avril, Inness Elizabeth L, Patterson Kara K
a Health and Rehabilitation Sciences , Western University , London , Canada.
b Department of Research , Toronto Rehab, University Health Network , Toronto , Canada.
Top Stroke Rehabil. 2016 Oct;23(5):326-32. doi: 10.1080/10749357.2016.1162396. Epub 2016 Mar 31.
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.
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).
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.
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.
中风康复的最佳实践建议在全面评估以识别特定损伤的指导下，针对个体缺陷进行干预。运动损伤与平衡之间的关系已得到充分研究，但足底皮肤感觉受损的作用却鲜为人知，尽管事实上41%的中风后个体存在这种缺陷。本研究的目的是：（1）描述足底感觉与站立平衡控制测量之间的关系；（2）确定与中风后平衡损伤相关的感觉损伤阈值。
从52份住院康复病历中提取单丝试验评分、站立平衡控制的测力台测量值和伯格平衡量表（BBS）评分。对感觉和平衡测量值进行斯皮尔曼相关性分析。完成受试者操作特征（ROC）分析，以确定能最佳区分平衡受损和未受损个体（根据压力中心[COP]在内外侧方向的变异性定义）的单丝评分。
患侧足部的足底感觉与闭眼站立时COP的前后变异性以及BBS评分相关。ROC分析确定，单丝截断值为4.31 log(mg)时，区分平衡受损个体的敏感性为73%，特异性为70%。
目前的结果表明，足底皮肤感觉缺陷会导致中风后平衡损伤。单丝截断评分可能有助于临床医生确定足底皮肤感觉受损是否是患者平衡缺陷的一个促成因素。
