Postural visual dependence after recent stroke: Assessment by optokinetic stimulation

Introduction: This study was conducted to assess visual dependence of postural control early after stroke. Design: Case control study. Setting: A Physical Medicine and Rehabilitation Department. Method: Twenty-five patients impaired by severe hemiplegia due to a recent first stroke, were examined. Fourteen had a right and I I a left hemispheric lesion. There were aged 52 +/- 13 years, time since stroke was 30 +/- 12 days. Patients' data were compared to data for 25 healthy subjects. Sitting posture was assessed on a dynamic balance, using two parameters: frontal plane displacement of the centre of pressure under optokinetic stimulation (OKS), and the total length of centre of pressure displacement for the stability reaction. On the basis of 90th percentile control data, patients' behaviour was classified as totally visuo independent (VI), totally visuo dependent (VD) or mixed. Results: Body tilt under OKS was greater in patients than controls. No control subject was totally VD, 19 subjects were totally VI. Four patients were totally VD and only six were VI. The only clinical parameter linked to the effect of OKS was the sensitivity impairment. Overall patients with visuospatial neglect were the most perturbed, but two were totally visuo independent. Discussion and conclusion: Assessment of postural variations in sitting under OKS is proposed for estimating visual dependence early after stroke. Individual reactions are more important than mean group reactions. Visual dependence is not solely due to neurological impairment, implying that previous physiological behaviour may be involved. Knowledge of these characteristics may affect rehabilitation programmes. (C) 2005 Elsevier B.V. All rights reserved.