Impaired ability to shift weight onto the non-paretic leg in right-cortical brain-damaged patients

• Published in: Clinical neurology and neurosurgery Vol. 112; no. 5; pp. 406 - 412
• Main Authors: Ishii, Fumiyasu, Matsukawa, Noriyuki, Horiba, Mitsuya, Yamanaka, Takehiko, Hattori, Manabu, Wada, Ikuo, Ojika, Kosei
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.06.2010; Elsevier; Elsevier Limited
• Subjects: Aged; Anosognosia; Biological and medical sciences; Cerebral Cortex - pathology; Cerebral Infarction - complications; Cerebral Infarction - pathology; Exercise; Female; Functional Laterality - physiology; Health Promotion; Humans; Instability; Lower Extremity - physiopathology; Male; Medical sciences; Neurology; Neurosurgery; Paresis - etiology; Paresis - physiopathology; Posture; Right hemisphere; Stroke; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Weight shift; Weight-Bearing; Stroke; LPI; NR; RPI; Right hemisphere; Anosognosia; LCI; Weight shift; RI; RCI; Instability; LI; 10s, 20s and 60s; NL; left hemispheric infarction in territory of middle cerebral cortical artery; left hemispheric infarction in territory of middle cerebral artery; 10, 20 and 60 s after starting to keep static position; right hemispheric infarction in territory of middle cerebral artery; right hemispheric infarction in territory of middle cerebral cortical artery; right hemispheric infarction in territory of middle cerebral perforating artery; normal control subjects through left leg; left hemispheric infarction in territory of middle cerebral perforating artery; normal control subjects through right leg; Human; Nervous system diseases; Cardiovascular disease; Cerebral disorder; Vascular disease; Surgery; Central nervous system disease; Cerebrovascular disease
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2010.02.006

: Stroke patients experience postural instability that can impede functional improvements in their gait. However, the precise functions of the dominant and non-dominant hemispheres in controlling static standing posture and weight-bearing remain unclear. : To investigate differences in balancing ability between right-handed patients with right and left hemispheric lesions. : Weight shifting was quantitatively evaluated to determine the ability of patients to control their balance in a static posture and during conscious weight shifting onto the paretic or non-paretic leg. Participants were enrolled from a consecutive series of stroke patients attending a rehabilitation program ( n = 49; 31 male, 18 female; mean age 69.3 ± 9.4 years). Age-matched normal controls were recruited as volunteers ( n = 12; 4 male, 8 female; mean age 67.9 ± 4.9 years). : Patients with cortical lesions in the right hemisphere were able to shift less weight onto the non-paretic leg than patients with cortical lesions in the left hemisphere ( p < 0.05). There were no correlations between the existence of unilateral spatial neglect and the percentage of weight shifted onto the non-paretic leg, static standing posture ( r = 0.27, p = 0.40) or dynamic standing posture ( r = −0.37, p = 0.24). In contrast, there was a significant correlation between the percentage of weight consciously shifted onto the non-paretic leg and the existence of anosognosia ( r = 0.74, p = 0.006), but not between static standing posture and anosognosia ( r = −0.15, p = 0.63). : Patients with right cortical hemispheric lesions were able to shift less body weight onto their non-paretic leg. These patients should be encouraged to practice shifting their weight towards their non-paretic leg to improve their balance.