Biofeedback rehabilitation of posture and weightbearing distribution in stroke: A center of foot pressure analysis

Alessandro Marco De Nunzio, Michelangelo Bartolo, Chiara Zucchella, Francesca Spicciato, Paolo Tortola, Francesco Pierelli, Michelangelo Bartolo, Chiara Zucchella, Carmine Vecchione, Carmine Vecchione, Francesco Pierelli

Research output: Contribution to journalArticlepeer-review


Weight bearing on the paretic lower extremity and transfer of weight from one lower extremity to the other are important goals of stroke rehabilitation. Improvements in these limb loading and weight transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic lower extremity loading and weight transfer have not been identified.

The purpose of this study was to quantitatively assess, through center of foot pressure (CoP) analysis of quiet upright stance control, recovery of paretic limb loading as a measure of weight transfer in early stroke subjects, testing the effectiveness of a targeted rehabilitation intervention based on audiovisual biofeedback.

Thirty-seven adults with lower extremity motor impairment following unilateral, non-cerebellar stroke, were Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis tested twice, at an interval of at least one month post stroke and following rehabilitation intervention aimed at correcting their asymmetrical weight bearing. The intervention was performed with (Study Group, SG) or without (Control Group, CG) a postural audio-visual biofeedback approach. Indices of postural stability and of balance control asymmetry were estimated by acquiring the movements of the CoP during quiet upright stance condition with or without visual input (eyes open, EO and eyes closed, EC). Clinical scales were also administered. Both the CG and the SG subjects showed improved control in upright stance posture as documented by significant improvements in the scale scores and indices of stability during both the EO and the EC condition. Only the SG showed a significantly reduced CoP index of asymmetry.

The CoP index of asymmetry, correlating with clinical motor scales, is a valid measure of paretic limb loading during stroke recovery. Postural audio-visual biofeedback represented the more effective approach for reducing weight loading asymmetry of the lower limbs in stroke.

Original languageEnglish
Pages (from-to)127-134
Number of pages8
JournalFunctional Neurology
Issue number2
Publication statusPublished - Apr 1 2014


  • Asymmetry index
  • Biofeedback
  • Neurorehabilitation
  • Posturography
  • Stroke
  • Weight bearing

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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