Sarah Tyson

BACKGROUND AND PURPOSE: Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. SUBJECTS: The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. METHODS: Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects' stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. RESULTS: A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. DISCUSSION AND CONCLUSION: Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.

OBJECTIVE: To identify psychometrically robust and clinically feasible measures of walking and mobility in people with neurological conditions. DATA SOURCES: MEDLINE, CINAHL, EMBASE, PEDro and AMED. REVIEW METHODS: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change or clinical utility of measures of walking and mobility in adult neurological conditions. Measures with 'good' psychometrics and 9/10 clinical utility scores were recommended. RESULTS: Seventeen measures were selected. Of these, the 5-m and 10-m walk tests, six-minute walk test, High Level Mobility Assessment Tool (HiMAT) and the Rivermead Mobility Index (RMI) reached the required standards and are usable in clinical practice. None of the recommended measures assessed wheelchair mobility. The least frequently assessed property was sensitivity to change. Further measures could be recommended if the minimal detectable change were demonstrated. CONCLUSION: The 5-m, 10-m and six-minute walk test, High Level Mobility Assessment Tool and the Rivermead Mobility Index are psychometrically robust measures of walking and mobility and are feasible for use in clinical practice.

OBJECTIVE: To characterize the nature of sensory impairments after stroke, identify associated factors, and assess the relationships between sensory impairment, disability, and recovery. METHODS: Prospective cross-sectional survey of 102 people with hemiparesis following their first stroke. Tactile and proprioceptive sensation in the affected arm and leg were measured using the Rivermead Assessment of Somatosensory Perception 2-4 weeks post-stroke. Demographics, stroke pathology, weakness, neglect, disability, and recovery were documented. RESULTS: Tactile impairment was more common than proprioceptive (P < .000), impairment of discrimination was more common than detection (P < .000), and tactile sensation was more severely impaired in the leg than the arm ( P < .000). No difference in proprioception between the arm and leg (P = .703) or between proximal and distal joints (P = .589, P = .705) was found. The degree of weakness and the degree of stroke severity were significantly associated with sensory impairment; demographics, stroke side and type, and neglect were not associated. All the sensory modalities were significantly related to independence, mobility, and recovery (r = 0.287 [P < .011] to r = 0.533 [P < .000]). CONCLUSION: Sensory impairments of all modalities are common after stroke, although tactile impairment is more frequent than proprioceptive loss, especially in the leg. They are associated with the degree of weakness and the degree of stroke severity but not demographics, stroke pathology, or neglect, and they are related to mobility, independence in activities of daily living, and recovery.

OBJECTIVE: To identify psychometrically robust and clinically feasible measurement tools of balance activity in people with neurological conditions to recommend for use in clinical practice. DATA SOURCES: MEDLINE, CINAHL, EMBASE, PEDro and AMED. REVIEW METHODS: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions. Quality assessment was based on Jorstad et al. Measures with 'good' psychometrics and > or =9/10 clinical utility scores were recommended. RESULTS: Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance Scale, Trunk Impairment Scale, arm raise and forward reach tests in sitting and standing, weight shift, step/tap and step-up tests reached the required standards and are usable in clinical practice. The Brunel Balance Assessment and its associated functional performance tests have the additional advantages of being a hierarchical scale with established lack of redundancy. CONCLUSION: The measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.