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Postural control disorders in stroke patients: neurophysiological, clinical and rehabilitation aspects


Author: Pascal Oleg
Degree:doctor habilitat of medicine
Speciality: 14.00.13 - Neurology
Year:2009
Scientific consultant: Diomid Gherman
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 19 November, 2008
Approved by NCAA on the 22 January, 2009

Abstract

Adobe PDF document0.74 Mb / in romanian

Thesis

CZU 616.831-005.1-07-08+616.89-008-08

Adobe PDF document 3.35 Mb / in romanian
207 pages


Keywords

stroke, post-stroke hemiparesis, postural control disorders, rehabilitation, computer stabilography, postural vertical, pushing phenomena, stabilographic parameters, falls in stroke, stabilographic biofeedback

Summary

The present study is based on clinical and neurophysiological follow-up investigation of 348 stroke patients throughout the 1th year of rehabilitation period after the stroke onset. The goal of this research was to study clinical and neurophysiological peculiarities of postural control disorders (PCD) in stroke patients, to identify the predictive stabilographic parameters for risk of falling and to evaluate the efficacy of postural stabilographic biofeedback in rehabilitation of stroke patients.

The study data showed a high incidence of PCD (82,2%) in patients throughout the 1th year of rehabilitation period after the stroke onset, the severity of PCD decreasing together with an increase in post-stroke. A great significance in post-stroke postural impairments was found to have a false perception of subjective postural vertical, manifested by contralesional tilt. The severity of PCD correlates with the tilt degree of the subjective postural vertical and with the association of hemispatial neglect, autotopagnosia and proprioception disorders. Patients with post-stroke “pusher” phenomenon have been proved to have a severe tilt in their perception of subjective postural vertical, a fact important in the elaboration of special postural retraining programs.

The evoked motor and somatosensory potentials have been studied according to the severity of PCD, this revealing the predominance of conductibility function disturbances over the impairments of the reactivity of motor and sensitive cortex in the affected hemisphere in post-stroke patients with severe PCD. The significant disorders in functional interaction between the sensitive and motor cortex of the affected cerebral hemisphere were revealed in patients with severe and moderate degree of post-stroke PCD. The study detected that impairments of conductibility function in the sensory system predominate up to 2 months after stroke onset, while disorders of the affected hemisphere reactivity predominate after that period. The revealed regularities in the neurophysiological modifications allow to improve the differential rehabilitation programs in accordance with the degree of PCD and post-stroke interval.The stabilographic study revealed different adaptive strategies used by patients with post-stroke hemiparesis to ensure their postural stability with different voluntary control influence on posture. The majority of them manifest displacements of the center of pressure to the nonparetic side, but there is a group of patients that ensure their stability by displacement of the center of pressure to the paretic side. These data should be used for an appropriate planning of therapeutic strategies. The predictive stabilographic parameters for the risk of falling in chronic post-stroke hemiparetic patients have been identified. The method of postural stabilographic biofeedback showed an efficacy in postural control improvement and decrease of spasticity in the paretic leg in post-stroke hemiparetic patients.