Asouzu NC, Mong E, Agha M, et al. Relationship between hamstrings–quadriceps strength ratio and the performance of tasks in Berg’s Balance Scale among stroke survivors in Abakaliki, Nigeria.

The full article can be found here.


Tell us more about yourself and the author team.

I am a physiotherapist specialising in rehabilitating individuals with mobility and balance challenges. I took on this study with a group of like-minded researchers to explore challenges of balance among stroke survivors to find a rehabilitation approach to overcoming the challenges.

What is the story behind your study?

In over 10 years of an exciting career in neurorehabilitation, a more significant percentage of my service users were stroke survivors. I observed that challenges of gait and balance give great concern both to stroke survivors and rehabilitation professionals. The population studied may not represent the entire population of stroke survivors in the geographical area because of the erroneous myth amongst some members of the populace that stroke is not treated in the hospital. The myth may be strengthened by the poor rehabilitation outcome of gait and balance among survivors of severe stroke.

In an attempt to address the challenge of balance among stroke survivors, the increased tone and strength observed in the extensors over the flexors of the lower limb stimulated an exciting consideration of intermuscular coordination of movements, performance of balance tasks and their relationships. This is because, after a stroke, there are unhindered excitatory descending inputs from the reticulospinal tract that increase spinal motor neuron excitability. This excitation favours the extensors (Quadriceps) with increased tone and strength against the flexors (hamstrings) of the affected lower limb.

In your own words, what did you find?

We found out that there is a wide gap between the muscle strength of extensors and flexors of the affected (paretic) lower limbs of stroke survivors in such a way that the hamstrings-quadriceps strength ratio is too poor compared to the values on the unaffected side. The strength ratio in the affected side correlated well with the performance of tasks in Berg’s balance scale. The relationship is such that the performance of the tasks increases as the strength ratio increases in the affected limbs of stroke survivors.

What was the main challenge you faced in your study?

The main challenge we faced during the study was that it involved a smaller population than was initially anticipated. Furthermore, more advanced and perhaps more accurate equipment could have been used for strength measurements if we had adequate fund for the study as the study was financed by the researchers.

If there is one takeaway message from your study, what would it be?

The primary takeaway from our study is that rehabilitation professionals should pay special attention to muscle strength ratios and intermuscular coordination of joint movements in the affected lower limbs to address the problem of balance among stroke survivors. Our study shows exceptional attention to hamstring strengthening in the affected limb may optimise intermuscular coordination and improve the hamstring quadriceps strength ratio, leading to better balance among stroke survivors.

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