A clinical model for the assessment of posture and balance in people with stroke.

Abstract

The lack of models to define and describe rehabilitation processes have often been identified as limiting research and the development of clinical practice. This study describes the development of a clinical model to address a key aspect of stroke physiotherapy--the assessment of posture and balance. Twenty seven experienced neurological physiotherapists (PT) in six focus groups were used. Participants were shown photographs of a typical stroke patient in sitting and standing positions and were asked 'What would you note if you were assessing the posture and balance of this patient?' Answers were displayed on flip charts to allow immediate feedback about the accuracy and completeness of data. Thematic content analysis was then used. A complex reasoning process emerged to answer three main questions: What can the patient do? How does s/he do it? Why does s/he do it that way? To answer these questions physiotherapists established balance disability (by observing the patient's ability to perform a series of increasingly demanding balance tasks), identified postural and movement impairments (by observing alignment and movement of body segments relative to each other and to the expected norm for that patient) and assessed muscle activity (by observation and palpation). Focus groups have been used to elicit a clinical model for the assessment of posture and balance, the content of which will be used to inform a new outcome measure.