The effect of weight-bearing asymmetry on dynamic postural stability in people with chronic stroke

After stroke, weight-bearing asymmetry (WBA) towards the non-paretic side is associated with postural instability. It remains unknown whether WBA is a cause or consequence of postural instability, as both phenomena depend on stroke severity. We investigated the effect of WBA on the ability to recover from balance perturbations in people with stroke. Fourteen people in the chronic phase of stroke underwent multidirectional translational perturbations at three levels of initial WBA (0, 10 and 20% of body weight unloading of the paretic leg). We iteratively determined the highest perturbation intensity that could be sustained with a feet-in-place response (i.e. stepping threshold) for each WBA condition and in four perturbation directions (forward, backward, towards paretic and towards non-paretic side). For perturbations above the stepping threshold we determined the choice of stepping leg. WBA increased the stepping threshold for perturbations towards the paretic side, whereas it decreased the stepping threshold for perturbations towards the non-paretic side (p<0.05). No effects of WBA were found on forward or backward stepping thresholds. Yet, the frequency of stepping with the paretic leg in the anteroposterior directions increased with greater WBA. Similarly, greater initial WBA resulted in a larger number of side steps towards the paretic side. In conclusion, the results suggest that people with stroke can benefit from some paretic leg unloading when perturbed towards the paretic side. It remains to be investigated, however, to what extent these benefits outweigh the potentially detrimental effects of WBA that were observed when recovering from perturbations in the other directions.