Department of Physiotherapy and Rehabilitation, Osmaniye Korkut Ata University, Osmaniye, Turkey.
Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA.
Int J Rehabil Res. 2022 Mar 1;45(1):72-78. doi: 10.1097/MRR.0000000000000515.
Individuals with stroke commonly have impaired balance control. The aim of this study was to investigate the effect of targeted intervention on anticipatory postural adjustments (APAs) and postural control in people with stroke. Six participants with unilateral hemiparesis due to a stroke (5.0-8.4 years post stroke) participated in a two-phase random crossover study. The participants received in counterbalanced order (a) 2 weeks of experimental, targeted intervention (pushing a medicine ball attached to the ceiling using their unaffected upper extremity) and (b) 2 weeks of control, self-guided general mobility exercise program with a 1-week washout period in between. All study participants were assessed with laboratory tests before and after each intervention. Lab tests included predictable external perturbations induced by a pendulum impact and clinical assessments of balance. Bilateral electromyographic activity of eight trunk and leg muscles and center of pressure (COP) displacements were recorded, and data during the anticipatory and compensatory phases of postural control were analyzed. After the experimental intervention, as compared to control intervention, the participants showed earlier APA onsets (P < 0.05), smaller COP displacements (P < 0.05), and improved [although not significantly (P >0.05)] scores of clinical tests of balance. The results of this feasibility study provide a foundation for developing balance rehabilitation protocols focused on improving APAs in individuals with neurological disorders.
患有中风的个体通常会出现平衡控制受损的情况。本研究的目的是探讨针对中风患者的姿势调整预测性（APAs）和姿势控制的靶向干预的效果。六名因中风导致单侧偏瘫的参与者（中风后 5.0-8.4 年）参与了一项两阶段随机交叉研究。参与者以平衡的方式接受了以下两种干预措施：（a）为期 2 周的实验性、靶向干预（使用未受影响的上肢将附着在天花板上的药球推出去）；（b）为期 2 周的对照、自我引导的一般运动训练计划，两者之间有 1 周的洗脱期。所有研究参与者在每次干预前后都接受了实验室测试。实验室测试包括由摆锤冲击引起的可预测的外部干扰以及平衡的临床评估。记录了八个躯干和腿部肌肉的双侧肌电图活动和压力中心（COP）位移，并对姿势控制的预测和补偿阶段的数据进行了分析。与对照干预相比，实验干预后，参与者的 APA 起始时间更早（P < 0.05），COP 位移更小（P < 0.05），并且平衡的临床测试评分有所提高（尽管没有显著差异（P > 0.05））。这项可行性研究的结果为开发针对改善神经障碍患者 APA 的平衡康复方案奠定了基础。
