title: Arm training in standing also improves postural control in participants with chronic stroke.
abstract: OBJECTIVE
  To prove the concept that postural control will improve without specific balance control training during arm training in standing with individuals with chronic stroke.
  
  
  METHODS
  Nine participants (mean age 64±7) received training involving hand orthotic assisted grasp, reach and release in standing 1 h, 3×'s/week for 6 weeks. Training focused on task completion with no explicit instructions provided for postural alignment, weight shift or balance strategy. Testing consisted of quantified measures using NeuroCom™ Balance Master, Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC).
  
  
  RESULTS
  Post training participants demonstrate increased (p<.05) composite stability scores for sensory organization testing (mean 71.55±12.7-75.55±11). Velocity and directional control of COP weight shift improved for all 9 subjects with 6/9 achieving 100% target acquisition. Directional control improved (p<.05) for medial/lateral movements for all speeds and composite score. Anterior/posterior rhythmic weight shifting increased significantly in COP velocity control at moderate and fast velocities and composite score. Increases in mean BBS (p<.01) from 41.33±10.1-46.88±8.03 exceeded the clinically important cutoff for the scale. Balance confidence improved with ABC mean scores 70.22±14.5-79.55±12.86 (p<.05). Seven participants demonstrated changes above the minimally important difference for this scale.
  
  
  CONCLUSIONS
  Postural control improved following task oriented arm training in standing without explicit postural control goals, instruction or feedback challenging current training paradigms of isolated postural control training with conscious attention directed to center of pressure location and movement.
authors.affiliation: University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, United States. smccombewaller@som.umaryland.edu
authors.forename: Sandy
authors.initials: S
authors.lastname: McCombe Waller
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Prettyman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D016896:Treatment Outcome