Objective: Sensory deficit is common in patients with stroke and seems to be related to balance and ambulation. Previous studies which have shown the association between sensory impairment and balance evaluated the integrity of sensory system by using clinical scoring system. The aim of the present study was to determine the relationship between parameters of somatosensory-evoked potential (SSEP) as quantitative measure and stability of gait and balance in supratentorial hemiplegic stroke patients after acute phase.
Method: We retrospectively reviewed the medical records for stroke patients who were admitted to the department of rehabilitation medicine from January 1, 2006 to February 28, 2019. Inclusion criteria were as follows: 1) patients with only supratentorial stroke; 2) interval between stroke onset and SSEP > 2 weeks; 3) MRC grade 4 or higher on hemiplegic lower extremities including hip flexor, knee extensor and ankle dorsiflexor; 4) independent gait before onset of stroke. We excluded 1) patients with a previous stroke, visual field defect, hemineglect, spasticity; 2) those with peripheral polyneuropathy of lower extremities confirmed by electrophysiologic study; 3) those with SSEP abnormalities at non-hemiplegic side. We divided 69 enrolled patients into two subgroups according to SSEP abnormalities of hemiplegic side (Figure 1). The criteria for abnormality of SSEP were delayed latency more than 43.9 msec and amplitude (P39-N50) less than 0.5 uV.
Results: The mean age of patients was 50.94, with 30 men and 47 ischemic stroke, and 11 patients had thalamic lesions. The mean score of BBS and FAC was 37.29 and 3.52 score, respectively. The mean latency and amplitude of SSEP at hemiplegic side was 44.05 and 2.29 respectively and mean of side-to-side difference was 3.38. The mean latency and amplitude of SSEP at non-hemiplegic side was 41.02 and 2.61, respectively (Table 1). Among 69 enrolled patients, 17 patients had the abnormalities of SSEP at hemiplegic side. The mean BBS scores of each subgroup was 38.50 and 33.59, and mean FAC scores was 3.67 and 3.06, respectively. In the group with abnormalities of SSEP, the score of BBS and FAC tended to be low, without reaching statistical significance (Table 2).
Conclusion: The dysfunction of balance and gait in hemiplegic patients with supratentorial stroke tended to be more severe in the group with abnormalities of SSEP compared to the group without abnormalities, albeit without statistical significance. The results were probably due to small sample size of enrolled patients and insensitivity of reference value of SSEP. |
