Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

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Dominance of Sensory Inputs in Maintaining Balance among Acute and Subacute Stroke Patients


Affiliations
1 Department of Physiotherapy, School of Therapeutic Science, Masterskill University College of Health Science (MUCH), Cheras, Selangor Darul Ehsan, Malaysia
2 Department of Physiotherapy, School of Therapeutic science, Masterskill University College of Health Science (MUCH), Cheras, Selangor Darul Ehsan, Malaysia
     

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Purpose of the study

Stroke leads to hemiparesis which further leads to poor balance. Established fact behind this balance problem is motor weakness and this study focuses on the influence of sensory system over imbalance among these subjects. The objective of the study was to analyze the influence of visual, vestibular and somatosensory systems in maintaining balance among acute and sub acute stroke patients using the CTSIB (Clinical Test For Sensory Integration and Balance) test&in addition to determine whether there are any alterations in the dominance of sensory inputs among sub acute stroke patients.

Metbods

A total of 31 patients with hemiparesis secondary to unilateral CVA were tested. Subjects were divided into an acute (A) and a sub acute (B) group. Study design: Descriptive study. Timed performances under six different conditions were compared across the two groups using the CTSIB. The CTSIB is a timed test in which the postural sway is measured while the subject stands quietly under 6 different conditions that alters the availability and accuracy of visual, vestibular and somatosensory inputs for postural orientation.

Results

Patients in the acute group demonstrated a poor score in all compliant surface conditions and a very low score in conditions 5 and 6 with a mean score of 5.56 and 8.25 respectively, whereas those of the sub acute groups have a higher mean of 23.73 and 28.93 respectively. When comparing the scores between the two groups using two way ANOVA, it was found that there was a statistically insignificant difference in conditions 1, 2 and 3. A statistically significant difference was noted in condition 4 (P< 0.05) and high level of significance was noted in conditions 5 and 6 between the groups with P value of < 0.001.

Discussion and conclusion

based on the results of this study it was concluded that patients with acute hemiplegia rely excessively on their visual system for maintaining balance and this becomes a natural compensatory strategy for coping with poor balance. Dominance or excessive reliance on the visual system among these patients causes suppression and masking of two other systems (vestibular and somatosensory). Unmasking of the influence of somatosensory system is seen in sub acute patients and this unmasking can occur as early as 1 to 5 months following stroke.


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  • Dominance of Sensory Inputs in Maintaining Balance among Acute and Subacute Stroke Patients

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Authors

Stanley John Winser
Department of Physiotherapy, School of Therapeutic Science, Masterskill University College of Health Science (MUCH), Cheras, Selangor Darul Ehsan, Malaysia
Priya Stanley
Department of Physiotherapy, School of Therapeutic science, Masterskill University College of Health Science (MUCH), Cheras, Selangor Darul Ehsan, Malaysia

Abstract


Purpose of the study

Stroke leads to hemiparesis which further leads to poor balance. Established fact behind this balance problem is motor weakness and this study focuses on the influence of sensory system over imbalance among these subjects. The objective of the study was to analyze the influence of visual, vestibular and somatosensory systems in maintaining balance among acute and sub acute stroke patients using the CTSIB (Clinical Test For Sensory Integration and Balance) test&in addition to determine whether there are any alterations in the dominance of sensory inputs among sub acute stroke patients.

Metbods

A total of 31 patients with hemiparesis secondary to unilateral CVA were tested. Subjects were divided into an acute (A) and a sub acute (B) group. Study design: Descriptive study. Timed performances under six different conditions were compared across the two groups using the CTSIB. The CTSIB is a timed test in which the postural sway is measured while the subject stands quietly under 6 different conditions that alters the availability and accuracy of visual, vestibular and somatosensory inputs for postural orientation.

Results

Patients in the acute group demonstrated a poor score in all compliant surface conditions and a very low score in conditions 5 and 6 with a mean score of 5.56 and 8.25 respectively, whereas those of the sub acute groups have a higher mean of 23.73 and 28.93 respectively. When comparing the scores between the two groups using two way ANOVA, it was found that there was a statistically insignificant difference in conditions 1, 2 and 3. A statistically significant difference was noted in condition 4 (P< 0.05) and high level of significance was noted in conditions 5 and 6 between the groups with P value of < 0.001.

Discussion and conclusion

based on the results of this study it was concluded that patients with acute hemiplegia rely excessively on their visual system for maintaining balance and this becomes a natural compensatory strategy for coping with poor balance. Dominance or excessive reliance on the visual system among these patients causes suppression and masking of two other systems (vestibular and somatosensory). Unmasking of the influence of somatosensory system is seen in sub acute patients and this unmasking can occur as early as 1 to 5 months following stroke.


References