Influence of sensory loss on the perception of verticality in stroke patients.

PURPOSE: The aim of this study was to investigate the relationship between somatosensory loss and perception of verticality in stroke patients suffering single-hemisphere lesions. METHOD: Somatosensory loss was measured using the Rivermead Assessment for Somatosensory Performance (RASP). Perception of verticality was assessed with the Subjective Visual Vertical (SVV) and the Subjective Postural Vertical (SPV) tests. Absolute Values of SVV and SPV were used to analyze the amount of deviation in relation to somatosensory loss. RESULTS: Thirty-two patients were included in the study (mean age = 45.91 SD = 31.88 years). Analysis showed that somatosensory loss was related to results of the SVV (r = -0.552, p = 0.001, Pearson Rank) and the SPV (r = -0.661, p < 0.001, Spearman Ï). Furthermore, results showed that both joint-related (SVV: r = -0.411, p = 0.019, Pearson Rank; SPV: r = -0.597, p = 0.001, Spearman Ï) and skin-related (SVV: r = -0.595, p < 0.001, Pearson Rank; SPV: r = -0.663, p < 0.001, Spearman Ï) somatosensory information is related to verticality perception. CONCLUSIONS: This study provides evidence that perception of verticality is related to somatosensory loss, which means that somatosensory loss will lead to a larger amount of deviation of SVV and SPV in relation to the gravitational vector. Furthermore, it is interesting to note that both SVV and SPV are influenced by somatosensory loss. IMPLICATIONS FOR REHABILITATION: • Somatosensory information is related to both visual and postural aspects of verticality perception. • Both joint- and cutaneous-related modalities of sensory information are related to perception of verticality. • Sensory training could be important in the recovery of verticality perception.

Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility.

BACKGROUND: Sitting balance and the ability to perform selective truncal movements are important predictors of functional outcome after stroke. However, few clinical trials have evaluated the effect of truncal exercises. OBJECTIVE: The authors assessed the effect of additional truncal exercises on truncal function, standing balance, and mobility. METHODS: An assessor-blinded randomized controlled trial was carried out at a stroke rehabilitation hospital. A total of 33 participants (mean 35 days post onset) were randomly assigned to an experimental group (n = 18) or a control group (n = 15). In addition to conventional therapy, the experimental group received 16 hours of truncal exercises. The control group received 16 hours of sham treatment. Truncal function was evaluated by the Trunk Impairment Scale (TIS) and standing balance and mobility by the Tinetti Test. The Romberg with eyes open and eyes closed, Four Test Balance Scale (FTBS), Berg Balance Scale (BBS), Rivermead Motor Assessment Battery (RMAB), Functional Ambulation Categories, and Dynamic Gait Index (DGI) were performed to elucidate the findings of the primary outcome measures. RESULTS: A treatment effect was found for the experimental group on the TIS (P < .001), Tinetti Test (P < .001), FTBS (P = .014), BBS (P = .007), RMAB (P < .001), and DGI (P = .006). CONCLUSIONS: In addition to conventional therapy, truncal exercises have a beneficial effect on truncal function, standing balance, and mobility in people after stroke.