The Relationship of Plantar Sensation with Standing Balance and Gait Post-Stroke

.............................................................................................................................. ii Table of Contents ............................................................................................................... iii List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1 ............................................................................................................................. 1 1 Introduction .................................................................................................................... 1 1.1 Stroke ...................................................................................................................... 2 1.2 Gait after Stroke ...................................................................................................... 3 1.2.1 Gait Velocity after Stroke ........................................................................... 5 1.2.2 Gait Asymmetry after Stroke ...................................................................... 5 1.2.3 Post-Stroke Deficits Related to Decreased Velocity and Asymmetry ........ 7 1.3 Standing Balance after Stroke ................................................................................. 9 1.3.1 Post-Stroke Deficits Related to Decreased Standing Balance .................. 12 1.4 Somatosensation after stroke ................................................................................ 13 1.5 Role of plantar cutaneous sensation in gait and balance ....................................... 15 1.6 Vision as compensation for sensory loss .............................................................. 18 1.7 Research Questions and Objectives ...................................................................... 19 Chapter 2 ........................................................................................................................... 21 2 Methods ........................................................................................................................ 21 2.1 BMFC Testing Protocol ........................................................................................ 21 2.1.1 Clinical Measures ...................................................................................... 22 2.1.2 Laboratory Measures ................................................................................ 25 2.2 Data Extraction ..................................................................................................... 27 2.3 Calculations and Measurements ........................................................................... 28 iv 2.3.1 Standing Balance: ..................................................................................... 28 2.3.2 Over-ground gait: ...................................................................................... 30 2.3.3 Classification by Plantar Sensation ........................................................... 31 2.3.4 Statistical Analysis .................................................................................... 32 Chapter 3 ........................................................................................................................... 35 3 Results .......................................................................................................................... 35 3.1 Participants ............................................................................................................ 35 3.2 Relationships between plantar sensation and balance and gait ............................. 38 3.3 Research Objective Results ................................................................................... 42 3.3.1 Research Objective 1: Plantar sensation and standing balance control .... 43 3.3.2 Research Objective 2: Plantar sensation and gait ..................................... 47 3.3.3 Research Objective 3: Plantar sensation, vision and control of posture ... 49 Chapter 4 ........................................................................................................................... 52 4 Discussion .................................................................................................................... 52 4.1 Deficits in Plantar Sensation Post-stroke .............................................................. 53 4.2 Quiet Standing Balance and Gait Deficits Post Stroke ......................................... 54 4.3 The use of vision as a compensatory strategy for instability ................................ 56 4.4 Research Objective 1: Plantar sensation and standing balance control ................ 57 4.5 Research Objective #2: Plantar Sensation and Gait .............................................. 58 4.6 Research Objective #3: Plantar sensation and compensation of vision for controlling upright posture .................................................................................... 62 4.7 Limitations ............................................................................................................ 63 4.8 Implications ........................................................................................................... 65 4.9 Future Directions .................................................................................................. 66 4.10 Conclusion and Summary ..................................................................................... 67 5 References .................................................................................................................... 68