Adaptation of Postural Stability following Stroke

Activities of daily living require both anticipatory and reactive postural adjustments. The influence of stroke on anticipatory and reactive balance behaviors is addressed in this article. Two primary deficits appear to underlie postural instability following stroke. The first deficit type is characterized by a loss of postural muscle recruitment in both lower extremities (not hyperactive stretch reflexes). The second deficit type is related specifically to the lack of limb stabilization on the paretic side of the body. These two categories of deficit might result from the disruption of geocentric and egocentric references for postural stability with cerebrovascular disease. Context-dependent postural responses are either relearned or retained following stroke, but deficits in the sequencing and timing of stabilizing neuromuscular responses appear to be resistant to adaptation. Prior knowledge of an impending balance disturbance improves the initiation of reactive postural adjustments in subjects with stroke but has no effect on the initiation of stabilizing responses associated with voluntary motion. The results suggest that reactive and anticipatory postural adjustments are controlled by different neural mechanisms and may require separate attention in a rehabilitation program.