Determinants of standing 1 month after stroke in a large cohort: motor weakness, lateropulsion, and hypoesthesia

Recovering standing balance after a stroke is an important milestone. However, the factors that affect post-stroke quiet standing balance remain unclear.

To determine the clinical profile of individuals according to their standing ability.

This cross-sectional study was conducted as part of the DOBRAS (Determinants of Balance Recovery After Stroke) cohort, which included individuals aged 18 to 80 years who had experienced a first unilateral hemisphere stroke. Three groups were formed based on the Postural Assessment Scale for Stroke score at 30 days post-stroke (D30): those unable to stand alone, those able to stand alone with difficulty, and those able to stand alone rather well. Sensorimotor and cognitive impairments were comprehensively assessed at D30. Data were analyzed by multivariate regression (14 impairments + age).

We analyzed data for 221 individuals (median age 67 years; 67 % male). Almost half (103/221, 47 %) could stand rather well, 33 % (73/221) could stand with difficulty, and 20 % (45/221) could not stand at all. The probability of being unable to stand alone increased with the severity of motor weakness (standardized logistic regression coefficient β₀ = 6.4), lateropulsion (β₀ = 4.4), and hypoesthesia (β₀ = 3.3). The probability of standing with difficulty increased with the severity of motor weakness (β₀ = 3.7), lateropulsion (β₀ = 2.1), and hypoesthesia (β₀ = 1.3) as well as with age (β₀ = 0.7).

One month after a hemisphere stroke, 53 % (118/221) of individuals do not stand or stand with difficulty, a proportion stable for 20 years. The standing posture should be considered more explicitly in modern post-stroke balance assessments, with more manageable postural tasks. The clinical profile of individuals with difficulty standing or inability to stand combines impairments in the elementary motor command (weakness), vertical orientation (lateropulsion), and somatosensory perception (hypoesthesia). They are also older. Focusing on these impairments and balance training could help people recover their standing posture after a stroke. Older individuals require more balance training.