Changes in balance and locomotion measures during rehabilitation following stroke

This study aimed to examine the utility of a number of measures of balance and locomotion for the purpose of measuring change in a group of stroke patients undergoing in-patient rehabilitation. The aim was to select a core group of measures based on empirical evidence of usefulness rather than personal preference.

Twenty-nine stroke patients undergoing in-patient rehabilitation (mean age 71.8 +/- 10.5 years; 66% male) participated in the study. A prospective design was utilized with repeated measurement undertaken at four, six and eight weeks post-stroke. Static standing, the Clinical Test of Sensory Interaction of Balance (CTSIB) (Shumway-Cook & Horak, 1986), functional reach (FR), repetitive reach (RR), step test (ST), gait velocity, stride length and the Motor Assessment Scale (Carr et al., 1985) (walking item) were assessed at each interval.

All measures of dynamic balance showed significant change over the four-week measurement period (p < 0.0036). Factor analysis identified two factors which grouped tests into static and dynamic, with a trend towards a third factor incorporating bipedal dynamic tests. Tests of static balance suffered from ceiling effects, whereas dynamic tests of balance and gait suffered from floor effects. Dynamic tests were more responsive (Standardized Response Measure (SRM) > 0.75) to change over the rehabilitation period than static tests.

The findings suggest that a clinically useful and responsive balance and mobility test battery should include one component of the CTSIB (Shumway-Cook & Horak, 1986), RR (step stance), ST and gait velocity.