Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention

Objective: To determine the role of symmetrical bodyweight distribution tra ining in preventing falls among patients with hemiplegic stroke. Design: A prospective study using a standing biofeedback trainer. Setting: Hospital-based rehabilitation units. Patients: Fifty-four patients with hemiplegic stroke (30 in the training gr oup, 24 in the control group). Interventions: Conventional stroke rehabilitation program, plus symmetrical standing training and repetitive sit-to-stand training, with a standing bi ofeedback trainer. Training effect was evaluated by assessing the sit-to-st and performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up. Main Outcome Measures: Occurrence of falls, sit-to-stand performance, inclu ding body-weight distribution, rate of rise in force, and sway in center of pressure (COP). Results: Significant improvement in sit-to-stand performance was found in p atients in the training group. Body weight was distributed more symmetrical ly in both legs, with less mediolateral sway in the COP when rising and sit ting down. The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decre ased, from 49.5% +/- 18.9% to 38.6% +/- 15.8% of body weight (BW) (p < .005 ). The rate of rise in force while rising from a chair significantly increa sed, from 28.3% +/- 13.5% BW/s to 53.6% +/- 20.5%BW/s (p < .001). At the 6- month follow-up, 10 of 24 patients (41.7%) in the control group had fallen, compared with only 5 of 30 patients (16.7%) in the training group (p < .05 ). Conclusions: Symmetrical body-weight distribution training may improve sit- to-stand performance and, consequently, decrease the number of falls by str oke patients.