title: Analysis of Balance during Functional Walking in Stroke Survivors.
abstract: BACKGROUND
  An important objective of rehabilitation care is to regain adequate balance function to safely ambulate in community. However, in rehabilitation practice, it remains unclear if a stroke survivor functionally recovers by restitution or by learning to compensate for the lack of restoration of body function. Aim of this study is to propose and evaluate methods for the objective evaluation of balance during functional walking in stroke survivors.
  
  
  METHODS
  Stroke survivors performed twice a Timed "Up & Go" (TUG) test. Ground reaction forces and position changes of both feet were measured using instrumented shoes and used to estimate the position of the center of mass (CoM). Balance control and efficiency metrics were defined to evaluate functional walking under variable conditions. Metrics were corrected based on the instantaneous velocity direction of CoM. Intra- and inter-participant variations for different phases of the TUG test were examined. Metrics were related to the Berg balance scale (BBS).
  
  
  RESULTS
  Participants with higher BBS scores show a more efficient walking pattern. Their walking velocity and walking direction is less variable and they are more frequently unstable when walking in a straight line or when turning. Furthermore, the less affected participants are able to move their CoM more towards their affected side.
  
  
  CONCLUSIONS
  We developed and demonstrated a method to assess walking balance of stroke survivors. System design and evaluation methods allow balance evaluation during functional walking in daily life. Some presented metrics show correlations with BBS scores. Clear inter- and intra-patient variations in metric values are present that cannot be explained by BBS scores, which supports the additional value of the presented system. Presented methods may be used for objective evaluation of restitution and compensation of walking balance and have a potential application in individual evidence-based therapy.
authors.affiliation: Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Fokke B
authors.identifier: http://orcid.org/0000-0002-5486-9663
authors.initials: FB
authors.lastname: van Meulen
authors.affiliation: Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Weenk
authors.affiliation: Biomechanical Engineering, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, 7500 AE, Enschede, the Netherlands.
authors.forename: Edwin H F
authors.initials: EH
authors.lastname: van Asseldonk
authors.affiliation: Xsens Technologies B.V., Enschede, the Netherlands.
authors.forename: H Martin
authors.initials: HM
authors.lastname: Schepers
authors.affiliation: Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Veltink
authors.affiliation: Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.|Roessingh Research and Development, Roessingh Rehabilitation Center. Enschede, the Netherlands.
authors.forename: Jaap H
authors.initials: JH
authors.lastname: Buurke
mesh_terms: D000368:Aged; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology*; D017741:Survivors; D016138:Walking / Q000502:physiology*