Recovery of standing balance and functional mobility after stroke1 S.Jayne Garland, PhD, Deborah A Willems, MSc, Tanya D Ivanova, PhD, Kimberly J Miller, MSc  Archives of Physical Medicine and Rehabilitation  Volume 84, Issue 12, Pages 1753-1759 (December 2003) DOI: 10.1016/j.apmr.2003.03.002

Fig 1 (A) The latency of the muscle burst in ipsilateral (nonparetic) and contralateral (paretic) hamstrings (HAMi, HAMc) and soleus (SOLi, SOLc) muscles. Data from each subject are presented in separate rows (admission, •; retest values after 4wk of rehabilitation, ○). The solid line at time 0 represents the time at which the forward arm movement started (ie, onset of arm acceleration). Muscle groups that were activated in a feed-forward anticipatory fashion have negative latencies and muscle groups that were activated in a feedback manner have positive latencies (after the arm begins to move). If the arm movement was not associated with any muscle burst, this is denoted by an ×, placed arbitrarily at 400ms when there is no burst at either testing. If there was no burst at admission but there was at retest, the × symbol is placed beside the retest latency. (B) The mean values for all subjects. Note the improved feed-forward control of hamstrings muscles after rehabilitation, indicated by significantly more negative latencies. Archives of Physical Medicine and Rehabilitation 2003 84, 1753-1759DOI: (10.1016/j.apmr.2003.03.002)

Fig 2 The relationship between the functional balance data and the physiologic measures of standing balance for each subject in (A) group I, (B) group IIa, and (C) group IIb. The BBS score is on the y axis and hamstring latency is on the x axis with ipsilateral (nonparetic) values on the left and contralateral (paretic) data on the right. Closed circles (•) represent data taken at admission; retest measurements are in open circles (○); and × indicates no burst. Arrows are placed between the admission and discharge data for each subject to enable visualization of change over time. Diagonal arrows going up and to the left indicate improvements in both functional and physiologic measures of standing balance. Arrows going vertically up indicate improvement in functional balance without concomitant improvement in physiologic indicators of standing balance. Archives of Physical Medicine and Rehabilitation 2003 84, 1753-1759DOI: (10.1016/j.apmr.2003.03.002)

Fig 3 A representative subject from (A) group I, (B) group IIa, and (C) group IIb is presented with admission data as a solid line and retest data as a dotted line. In each panel, the top trace is arm acceleration during the forward arm raise, the bottom 2 traces are the ipsilateral (nonparetic) and contralateral (paretic) hamstrings electromyographic burst. The dashed line at time 0 represents the onset of arm acceleration. Note the improved feed-forward response in both nonparetic and paretic hamstrings bursts in group I despite a lower arm acceleration. In group IIa, the subject had an improved electromyographic burst in the paretic hamstrings muscle without any notable change in arm acceleration. In group IIb, the subject was able to raise the arm with increased acceleration, accompanied by a large increase in the nonparetic hamstrings and little change in the paretic hamstrings. This represents a compensatory strategy involving the nonparetic limb. Archives of Physical Medicine and Rehabilitation 2003 84, 1753-1759DOI: (10.1016/j.apmr.2003.03.002)