Is the recovery of functional balance and mobility accompanied by physiological recovery in people with severe impairments after stroke?

BACKGROUND: Rehabilitation after severe stroke is often limited because of impairments in sensorimotor function. Functional and physiological recovery after severe stroke is poorly understood and has not been studied extensively.

OBJECTIVE: This study's purpose was to examine functional and physiological recovery of standing balance during inpatient rehabilitation in people with severe impairments after stroke.

METHODS: A total of 10 participants with severe impairments after stroke were evaluated monthly in a stroke rehabilitation unit with the following functional outcome measures: Berg Balance Scale (BBS), Clinical Outcome Variables Scale (COVS), and Chedoke McMaster Stroke Assessment (CMSA). Weight bearing (WB), center of pressure (COP) velocity, and electromyography (EMG) data were collected during quiet standing and during internal perturbation with a rapid nonparetic arm raise.

RESULTS: Cross-sectionally, there were moderate to strong correlations for EMG area and WB with CMSA and COVS. Additionally, the BBS was correlated with WB on the paretic side. Longitudinally, statistically significant improvement was found for functional measures but not for physiological measures. The mean BBS and COVS improved by 23 and 21 points, respectively. COP velocity decreased by 60.1% on the paretic leg but not significantly.

CONCLUSIONS: During stroke rehabilitation, all participants improved functionally. Some patients improved physiologically, though near discharge, all participants remained very impaired. Future studies with larger sample sizes are needed to explore the capacity for physiological recovery in this population.