Weight-bearing asymmetry patterns in patients with stroke: a systematic review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262194Keywords:
Stroke, Weight-bearing asymmetry, Postural controlAbstract
Stroke frequently results in weight-bearing asymmetry (WBA), a common motor impairment that negatively affects postural stability, gait, and increases fall risk. Identifying asymmetry patterns and reliable assessment methods is essential for individualized rehabilitation. This systematic review synthesized evidence on weight-bearing asymmetry patterns in stroke survivors and the tools used to assess and quantify them. The review followed PRISMA guidelines. A literature search of PubMed and Google Scholar identified randomized controlled trials published between 2015 and 2025 using keywords related to stroke, hemiplegia, weight bearing, postural control, postural sway, asymmetry patterns, and measurement methods. Eligible studies included individuals with stroke, objective evaluation of WBA, and reporting of asymmetry patterns and measurement tools. Data extraction focused on asymmetry types, assessment methods, and intervention approaches. 7 randomized controlled trials involving approximately 266 participants were included. Common WBA patterns included greater loading on the non-paretic limb, lateral weight shift, and reduced paretic limb loading during static and dynamic tasks. Measurement tools included force platforms, GAITRite systems, weight-bearing scales, and clinical balance measures. Interventions including insoles, weighted gait training, modified sit-to-stand training emphasizing symmetry, ankle–foot orthoses, shoe lifts on the non-paretic limb, tilt-based postural training, and weight-shift-triggered electrical stimulation improved symmetry indices and functional outcomes. Force platforms and symmetry indices were the most reliable methods for capturing static and dynamic asymmetries. Accurate assessment combined with targeted interventions can enhance postural control, gait symmetry, and functional recovery after stroke survivors during rehabilitation programs and clinical practice.
References
Liu M, Chen J, Fan W, Mu J, Zhang J, Wang L, et al. Effects of modified sit-to-stand training on balance control in hemiplegic stroke patients: a randomized controlled trial. Clin Rehabil. 2016;30(7):627-36.
Ribeiro TS, Gomes de Souza E Silva EM, Regalado ICR, Silva STD, Sousa CO, Ribeiro KMOBF, et al. Effects of load addition during gait training on weight-bearing and temporal asymmetry after stroke: a randomized clinical trial. Am J Phys Med Rehabil. 2020;99(3):250-6.
Park C, Woo Y, Won J, Kim S. Immediate effects of insoles applied to the sound side lower extremity of patients with chronic hemiplegia during walking. Restor Neurol Neurosci. 2024;42(2):167-77.
Birnbaum M, Brock K, Clark R, Muir S, Burton E, Hill KD. Standing weight-bearing asymmetry in adults with lateropulsion following stroke. Gait Posture. 2021;90:427-33.
Lee K. Balance training with weight shift-triggered electrical stimulation for stroke patients: a randomized controlled trial. Brain Sci. 2023;13(2):225.
An CM, Ko MH, Kim DH, Kim GW. Effect of postural training using a whole-body tilt apparatus in subacute stroke patients with lateropulsion: a single-blinded randomized controlled trial. Ann Phys Rehabil Med. 2021;64(2):101393.
Sheikh M, Hosseini HA. A randomized controlled study assessing the effects of a shoe lift under the nonparetic leg on balance performance in individuals with chronic stroke. J Geriatr Phys Ther. 2021;44(4):219-26.
Pérennou DA, Mazibrada G, Chauvineau V, Greenwood R, Rothwell J, Gresty MA, et al. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain. 2008;131(9):2401-13.
Pedersen PM, Wandel A, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. Arch Phys Med Rehabil. 1996;77(1):25-8.
Alabdulwahab SS, Ahmed F, Singh H. Effects of functional limb overloading on symmetrical weight bearing, walking speed, perceived mobility and community participation among patients with chronic stroke. Rehabil Res Pract. 2015;2015:1-6.
Cheng PT, Liaw MY, Wong MK, Tang FT, Lee MY, Lin PS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil. 1998;79(9):1043-6.
Tung FL, Yang YR, Lee CC, Wang RY. Balance outcomes after additional sit to stand training in subjects with stroke: a randomized controlled trial. Clin Rehabil. 2010;24(6):533-42.
Ribeiro TS, Silva EMGS, Silva IAP, Costa MFP, Cavalcanti FAC, Lindquist ARR. Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: a randomized controlled clinical trial. Gait Posture. 2017;54:229-35.
Ribeiro TS, Chaves da Silva TC, Carlos R, de Souza E Silva EMG, Lacerda MO, Spaniol AP, et al. Is there influence of the load addition during treadmill training on cardiovascular parameters and gait performance in patients with stroke? A randomized clinical trial. NeuroRehabilitation. 2017;40(3):345-54.
An B, Woo Y, Park K, Kim S. Effects of insole on the less affected side during execution of treadmill walking training on gait ability in chronic stroke patients: a preliminary study. Restor Neurol Neurosci. 2020;38(5):375-84.
Choi H, Kim WS. Anterior-posterior displacement of centre of pressure measured by insole foot pressure measurement system in subacute recovery stage of post stroke hemiplegia. Technol Health Care. 2018;26(4):649-57.
Birnbaum M, Brock K, Clark R, Burton E, Hill KD. Six month outcomes and patterns of recovery for people with lateropulsion following stroke. Disabil Rehabil. 2023;46(11):1-9.
Aruin AS. Compelled body weight shift approach in rehabilitation of individuals with chronic stroke. Top Stroke Rehabil. 2012;19(6):556-63.
Chung Y, Kim JH, Cha Y, Hwang S. Therapeutic effect of functional electrical stimulation triggered gait training corresponding gait cycle for stroke. Gait Posture. 2014;40:471-5.
Yun N, Joo MC, Kim SC, Min SK. Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. Ann Phys Rehabil Med. 2019;62(3):233-40.
Kim CY, Lee JS, Kim HD, Kim JS, Lee IH. Progressive task-oriented training on a supplementary tilt table improves lower extremity muscle activation and gait recovery in patients with hemiplegic stroke. Gait Posture. 2015;41(2):425-30.
Someshwar H, Ganvir S, Kunde C. Predicting the probability of falls in geriatrics using traditional timed up and go test and dual-task constraint timed up and go test: an observational study. Phys Ther. 2000;80(9):896-903.