Foot-Ground Force Quantifies Impaired Balance Control Mechanisms Post-Stroke

Approximately 50% of stroke survivors experience lasting balance impairments that persist and that are often managed through compensatory, but suboptimal, strategies. Identifying neuromechanical control changes after stroke could enable more targeted and effective rehabilitation strategies. Computational modeling has begun to uncover balance control strategies in unimpaired adults, but efforts have been limited post-stroke. Here we show one of the first instances of a model of quiet stance that reveals distinct control strategies in post-stroke individuals compared to similarly-aged unimpaired participants. Quiet standing was modeled using a double-inverted pendulum with full-state feedback control. The controller parameters were fit to foot-ground force data collected from 12 post-stroke and 22 similarly-aged unimpaired participants. The best-fit models revealed a joint-torque-coordination pattern in the paretic limb of post-stroke participants that differed substantially from that of the unimpaired participants. The post-stroke participants non-paretic limb also showed increased reliance on neural feedback, which may quantify compensatory effort for the altered coordination in the paretic limb. The results demonstrate that model-based analysis of foot-ground force behavior can reveal clinically meaningful insights that are not captured by traditional assessments.