BALANCED BASED TORSO WEIGHTING: A DEMONSTRATION OF THE IMMEDIATE IMPACTS ON TEMPORAL, SPATIAL, AND GAIT KINEMATICS IN A WOMAN WITH A PARIETAL STROKE. Cynthia Gibson-Horn*1; Sandra Radtka2 1. Physical Therapy, Rehab Without Walls, San Jose, CA; 2. Graduate Program in Physical Therapy, University of California/San Francisco State University, San Francisco, CA UNIQUE: Decreased postural control after stroke can adversely affect walking velocity, stride length, cadence, and gait kinematics. While weighting the body has been shown to improve function in those with ataxia, there is little information on balance-based, specific placement of small amounts of weight to counteract dysfunction in individuals post-stroke. PURPOSE: The purpose of this case study was to determine the immediate effects of Balance-Based Torso Weighting (BBTW) on temporal, spatial, and gait kinematics with a patient post-stroke. FOUNDATION: Postural control is a necessary foundation of smooth, controlled movement. Stability is often influenced by one's ability to anticipate or react to the environment. BBTW initially involves examination of anticipatory and reactive postural control. Once a balance dyfunction is determined, small amounts of weight (1-2% body weight) are strategically placed on the trunk to counteract the identfied dysfunction. DESCRIPTION: The patient was diagnosed with a right parietal cerebral vascular accident(CVA) six weeks prior to the evaluation. Her past medical history was significant for a previous left sided stroke, hypertension, headaches, depression, and long-term past cocaine abuse. The physical therapy evaluation included measurement of range of motion, strength, tone, balance, mobility, and weight. The patient weighed 145 pounds. The most pronounced problems were strength, balance, mobility, and gait. Anticipatory and reactive balance testing revealed a right posterior lateral balance dyfunction. A one-half pound vest was weighted with an additional one-half pound, placed in the left anterior lower pocket of a vest. The patient was retested and had less posterior lateral balance dysfunction. The patient was tested with and without BBTW with motion analysis during forward ambulation. OBSERVATIONS: Baseline characteristics revealed the patient ambulated with an average walking velocity of 59 cm/sec (normal is 124.8), with a stride length of 70 cm (normal is 149 cm), and a cadence of 98 steps per minute (normal is 100 steps per min). Step length on the right was 35.4 cm and the left was 35.8 cm (normal is 65 cm). In the BBTW condition the patient ambulated with an average walking velocity of 80 cm/sec, with a stride length of 96 cm, and a cadence of 99.3 steps per minute. The right step length increased to 49.8 cm and the left to 47.7 cm. In addition, gait kinematics improved bilaterally. On the right side, she showed improved pelvic obliquity closer toward normal during stance, reduced pelvic tilt toward normal in stance and swing, hip adduction closer toward normal in mid to late stance and intial swing, hip flexion/extension at normal for stance and swing, hip rotation closer toward normal during stance, but reduced knee flexion during mid to terminal stance. On the left side, the patient showed improved pelvic obliquity toward normal in midstance, increased hip adduction toward normal during midstance, improved knee flexion during terminal stance and swing, and improved plantar flexion during terminal stance, but had excessive pelvic rotation in the BBTW condition. CONCLUSIONS: BBTW appeared to have an immediate beneficial impact on temporal, spatial, and gait kinematics with this subject with a right parietal CVA. Treating the trunk may have provided the proximal stability needed for the distal mobility changes seen in this subject. Further research is indicated to evaluate BBTW with individuals with CVA to investigate whether the location of the brain injury influences weight placement. Electromyography to investigate if the muscles fire differently would also be interesting. FUNDING SOURCE: There was no funding for this study. KEYWORDS: Balance, Gait, Stroke, Postural Control, Torso Weight Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.