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Parietal-Insular Strokes Are Associated with Impaired Standing Balance as Assessed by Computerized Dynamic Posturography

The Burke Rehabilitation Hospital and Department of Neurology, Cornell University Medical College, 785 Mamaroneck Avenue, White Plains, New York, 10605

Ruth Leah R. Mauricio

The Burke Rehabilitation Hospital and Department of Neurology, Cornell University Medical College, 785 Mamaroneck Avenue, White Plains, New York, 10605

Michael J. Reding

The Burke Rehabilitation Hospital and Department of Neurology, Cornell University Medical College, 785 Mamaroneck Avenue, White Plains, New York, 10605

Objective: To identify the location of supratentorial strokes associated with impaired standing balance not due to hemiparesis, proprioceptive deficit, or visual-vestibular abnormality as assessed by computerized dynamic posturography (CDP). Design: Patients with impaired standing balance (ISB group) were identified with initial supra tentorial stroke who could stand unassisted with eyes open on a stable platform (CDP condition 1) but could not stand with eyes closed on a sway-referenced platform (CDP condition 5). A second group of patients who could maintain standing balance dur ing both CDP conditions 1 and 5 were selected as controls (control group). Com posite CT lesion templates of patients in the ISB group were compared with those of patients in the control group. Setting: An inpatient stroke rehabilitation unit with a mean study entry date of 34 ± 22 SD days post stroke. Results: The ISB group had significantly more lesions in the insula and subinsular white matter than the control group (p < 0.05). Seventeen of 25 patients in the ISB group (68%) had lesions in the insula or adjacent structures: superior temporal gyrus, frontal operculum, subin sular white matter, putamen. None of eight patients in the control group had lesions in these areas. Conclusions: The parietal-insular cortex of man may represent a cor tical integration area necessary for recovery of standing balance during the first two months following supratentorial stroke. Key Words: Vestibular cortex—Dynamic posturography—EquiTest—Balance—Stroke.

Neurorehabilitation and Neural Repair, Vol. 11, No. 1, 35-40 (1997)
DOI: 10.1177/154596839701100106


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