The relationships between proprioceptive awareness, balance, and spasticity in patients post-stroke with varying levels of trunk impairment.

Abstract

Background: Cervical and trunk proprioceptive deficits resulting from impaired sensorimotor integration post-stroke may contribute to deficiencies in balance reactions and tone regulation.Purpose: To examine relationships between cervical and trunk proprioceptive awareness, balance, and lower extremity spasticity in patients post-stroke with varying levels of trunk control.

Methods: This single-center cross-sectional observational study included patients post-stroke aged 35-65 years, stratified into low trunk control (LTC) and high trunk control (HTC) groups. Cervical proprioception was assessed using the Cervical Joint Position Error Test (CJPET), trunk proprioception using the Trunk Proprioception Test (TPT), balance performance using the Tecnobody ProKin 252 system, and lower extremity spasticity using the Modified Tardieu Scale (MTS).

Results: Ninety-eight patients post-stroke participated in the study (n = 49 per group). The LTC group demonstrated significantly higher CJPET, TPT, and MTS scores and lower balance performance compared with the HTC group (p = .003-0.001). In the LTC group, CJPET scores showed limited associations with static balance and spasticity measures. Conversely, in the HTC group, higher CJPET scores, except left rotation, were significantly associated with both higher MTS X scores and greater spasticity angles in proximal lower extremity muscles (ρ = 0.318-0.394, p = .026-0.005). Weak-to-moderate but significant correlations were observed between cervical lateral flexion and rotation errors and ankle plantar flexor spasticity (ρ = 0.288-0.303, p = .045-0.034). TPT scores were significantly associated with dynamic balance in LTC group (ρ = 0.282-0.412, p = .050-0.003) and with static balance in HTC group (ρ = 0.328-0.706, p = .021-0.001). TPT scores were not correlated with spasticity in either group.

Conclusion: Trunk control modulates the role of cervical and trunk proprioception in balance and spasticity post-stroke. Cervical proprioception primarily influences static balance and spasticity, whereas trunk proprioception supports dynamic balance when trunk stability is reduced.