Ann Rehabil Med.  2013 Dec;37(6):862-870. 10.5535/arm.2013.37.6.862.

The Effects of Visual and Haptic Vertical Stimulation on Standing Balance in Stroke Patients

• Hong SH
• Im S
• Park GY

• KMID: 2266565
• DOI: http://doi.org/10.5535/arm.2013.37.6.862

Abstract

OBJECTIVE
To explore the effect of visual and haptic vertical stimulation on standing balance in post-stroke patients.
METHODS
Twenty-five post-stroke patients were recruited. We measured left/right standing pressure differences and the center of pressure (COP) parameters for each patient under three different conditions: no stimulation, visual, and haptic stimulated conditions. First, patients stood on a posturography platform with their eyes blindfolded. After a rest period, the patients stood on the same platform with their eyes fixed to a 1.5-m luminous rod, which was placed at a vertical position in front of the patients. After another rest period, the patients again stood touching a vertically placed long rod in their non-hemiplegic hand with their eyes blindfolded. We collected the signals from the feet in each condition and obtained the balance indices.
RESULTS
Compared with the no stimulation condition, significant improvements were observed for most of the COP parameters including COP area, length, and velocity for both the visual and haptic vertical stimulation conditions (p<0.01). Additionally, when we compared visual and haptic vertical stimulation, visual vertical stimulation was superior to haptic stimulation for all COP parameters (p<0.01). Left/right standing pressure differences, increased, although patients bore more weight on their paretic side when vertical stimulation was applied (p>0.01).
CONCLUSION
Both visual and haptic vertical stimulation improved standing steadiness of post-stroke patients. Notably, visual vertical stimulation was more effective than haptic stimulation.

Keyword

Stroke; Rehabilitation; Hemiplegia; Postural balance; Stimulation

MeSH Terms

Foot
Hand
Hemiplegia
Humans
Photic Stimulation
Postural Balance
Rehabilitation
Stroke*

Reference

1. Bonan IV, Colle FM, Guichard JP, Vicaut E, Eisenfisz M, Tran Ba Huy P, et al. Reliance on visual information after stroke. Part I: Balance on dynamic posturography. Arch Phys Med Rehabil. 2004; 85:268–273. PMID: 14966712.

2. Wing AM, Goodrich S, Virji-Babul N, Jenner JR, Clapp S. Balance evaluation in hemiparetic stroke patients using lateral forces applied to the hip. Arch Phys Med Rehabil. 1993; 74:292–299. PMID: 8439258.

3. de Haart M, Geurts AC, Huidekoper SC, Fasotti L, van Limbeek J. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil. 2004; 85:886–895. PMID: 15179641.

4. Bonan IV, Guettard E, Leman MC, Colle FM, Yelnik AP. Subjective visual vertical perception relates to balance in acute stroke. Arch Phys Med Rehabil. 2006; 87:642–646. PMID: 16635626.

5. Yelnik AP, Lebreton FO, Bonan IV, Colle FM, Meurin FA, Guichard JP, et al. Perception of verticality after recent cerebral hemispheric stroke. Stroke. 2002; 33:2247–2253. PMID: 12215595.

6. Broetz D, Johannsen L, Karnath HO. Time course of 'pusher syndrome' under visual feedback treatment. Physiother Res Int. 2004; 9:138–143. PMID: 15560671.

7. Cunha BP, Alouche SR, Araujo IM, Freitas SM. Individuals with post-stroke hemiparesis are able to use additional sensory information to reduce postural sway. Neurosci Lett. 2012; 513:6–11. PMID: 22342925.

8. Johansson BB, Haker E, von Arbin M, Britton M, Langstrom G, Terent A, et al. Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial. Stroke. 2001; 32:707–713. PMID: 11239191.

9. Robertson JA, Eng JJ, Hung C. The effect of functional electrical stimulation on balance function and balance confidence in community-dwelling individuals with stroke. Physiother Can. 2010; 62:114–119. PMID: 21359041.

10. Woodford H, Price C. EMG biofeedback for the recovery of motor function after stroke. Cochrane Database Syst Rev. 2007; (2):CD004585. PMID: 17443550.

11. Geiger RA, Allen JB, O'Keefe J, Hicks RR. Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/force-plate training. Phys Ther. 2001; 81:995–1005. PMID: 11276182.

12. Pollock A, Baer G, Langhorne P, Pomeroy V. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review. Clin Rehabil. 2007; 21:395–410. PMID: 17613560.

13. Barra J, Marquer A, Joassin R, Reymond C, Metge L, Chauvineau V, et al. Humans use internal models to construct and update a sense of verticality. Brain. 2010; 133(Pt 12):3552–3563. PMID: 21097492.

14. Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Van de Heyning P. Influence of sensory loss on the perception of verticality in stroke patients. Disabil Rehabil. 2012; 34:1965–1970. PMID: 22506667.

15. Bonan IV, Leman MC, Legargasson JF, Guichard JP, Yelnik AP. Evolution of subjective visual vertical perturbation after stroke. Neurorehabil Neural Repair. 2006; 20:484–491. PMID: 17082504.

16. Bronstein AM, Perennou DA, Guerraz M, Playford D, Rudge P. Dissociation of visual and haptic vertical in two patients with vestibular nuclear lesions. Neurology. 2003; 61:1260–1262. PMID: 14610132.

17. Perennou DA, Amblard B, Laassel el M, Benaim C, Herisson C, Pelissier J. Understanding the pusher behavior of some stroke patients with spatial deficits: a pilot study. Arch Phys Med Rehabil. 2002; 83:570–575. PMID: 11932865.

18. Perennou D. Postural disorders and spatial neglect in stroke patients: a strong association. Restor Neurol Neurosci. 2006; 24:319–334. PMID: 17119307.

19. Barra J, Oujamaa L, Chauvineau V, Rougier P, Perennou D. Asymmetric standing posture after stroke is related to a biased egocentric coordinate system. Neurology. 2009; 72:1582–1587. PMID: 19414725.

20. Nichols DS. Balance retraining after stroke using force platform biofeedback. Phys Ther. 1997; 77:553–558. PMID: 9149764.

21. Gopalai AA, Senanayake SM, Kiong LC, Gouwanda D. Real-time stability measurement system for postural control. J Bodyw Mov Ther. 2011; 15:453–464. PMID: 21943619.

22. Dalleau G, Allard MS, Beaulieu M, Rivard CH, Allard P. Free moment contribution to quiet standing in able-bodied and scoliotic girls. Eur Spine J. 2007; 16:1593–1599. PMID: 17566794.

23. Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait Posture. 2005; 22:267–281. PMID: 16214666.

24. Gentaz E, Hatwell Y. Role of gravitational cues in the haptic perception of orientation. Percept Psychophys. 1996; 58:1278–1292. PMID: 8961837.

25. Sozzi S, Do MC, Monti A, Schieppati M. Sensorimotor integration during stance: processing time of active or passive addition or withdrawal of visual or haptic information. Neuroscience. 2012; 212:59–76. PMID: 22516013.

26. de Oliveira CB, de Medeiros IR, Frota NA, Greters ME, Conforto AB. Balance control in hemiparetic stroke patients: main tools for evaluation. J Rehabil Res Dev. 2008; 45:1215–1226. PMID: 19235121.

27. Anastasopoulos D, Haslwanter T, Bronstein A, Fetter M, Dichgans J. Dissociation between the perception of body verticality and the visual vertical in acute peripheral vestibular disorder in humans. Neurosci Lett. 1997; 233:151–153. PMID: 9350855.

28. Mansfield A, Danells CJ, Zettel JL, Black SE, McIlroy WE. Determinants and consequences for standing balance of spontaneous weight-bearing on the paretic side among individuals with chronic stroke. Gait Posture. 2013; 38:428–432. PMID: 23357758.

29. Roerdink M, Geurts AC, deHaart M, Beek PJ. On the relative contribution of the paretic leg to the control of posture after stroke. Neurorehabil Neural Repair. 2009; 23:267–274. PMID: 19074685.

30. Kamphuis JF, de Kam D, Geurts AC, Weerdesteyn V. Is weight-bearing asymmetry associated with postural instability after stroke? A systematic review. Stroke Res Treat. 2013; 2013:692137. PMID: 23738232.

31. Genthon N, Rougier P, Gissot AS, Froger J, Pelissier J, Perennou D. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008; 39:1793–1799. PMID: 18369174.