Reactive postural control deficits in patients with posterior parietal cortex lesions after stroke and the influence of auditory cueing

Objective: The purpose of this study was to investigate the ways in which stroke-induced posterior parietal cortex (PPC) lesions affect reactive postural responses and whether providing auditory cues modulates these responses.

Design: Seventeen hemiparetic patients after stroke, nine with PPC lesions (PPC_Lesion) and eight with intact PPCs (PPC_Spared), and nine age-matched healthy adults completed a lateral-pull perturbation experiment under noncued and cued conditions. The activation rates of the gluteus medius muscle ipsilateral (GMi) and contralateral to the pull direction, the rates of occurrence of three types of GM activation patterns, and the GMi contraction latency were investigated.

Results: In noncued pulls toward the paretic side, of the three groups, the PPC_Lesion group exhibited the lowest activation rate (56%) of the GMi (P <0.05), which is the primary postural muscle involved in this task, and the highest rate of occurrence (33%) of the gluteus medius muscle contralateralYactivation-only pattern (P <0.05), which is a compensatory activation pattern. In contrast, in cued pulls toward the paretic side, the PPC_Lesion group was able to increase the activation rate of the GMi to a level (81%) such that there became no significant differences in activation rate of the GMi among the three groups (P > 0.05). However, there were no significant differences in the GM activation patterns and GMi contraction latency between the noncued and cued conditions for the PPC_Lesion group (P > 0.05).

Conclusions: The PPC_Lesion patients had greater deficits in recruiting paretic muscles and were more likely to use the compensatory muscle activation pattern for postural reactions than the PPC_Spared patients, suggesting that PPC is part of the neural circuitry involved in reactive postural control in response to lateral perturbations. The auditory cueing used in this study, however, did not significantly modify the muscle activation patterns in the PPC_Lesion patients. More research is needed to explore the type and structure of cueing that could effectively improve patterns and speed of postural responses in these patients.