Relationship of proprioceptive awareness with balance and spasticity in stroke patients with different trunk involvement levels

Stroke patients often experience trunk impairments accompanied by various sensory and motor problems. The aim of this study is to investigate the relationship between proprioceptive awareness, balance, and spasticity in stroke patients with different levels of trunk involvement. A total of 98 stroke patients were divided into two groups based on their trunk control: low trunk control (LTC) and high trunk control (HTC). Cervical proprioceptive awareness was assessed using the Cervical Joint Position Error Test (CJPET), while lower extremity proprioceptive awareness and balance skills were evaluated using the Technobody Prokin 252 Isokinetic Balance Platform. Spasticity was measured using the Modified Tardiue Scale (MTS), and quality of life was assessed with the Stroke-Specific Quality of Life Scale (SS-QOLS). The HTC group demonstrated significantly lower error scores in the CJPET and lower extremity proprioceptive deviation, higher static and dynamic balance skills, lower MTS scores, and significantly higher SS-QOLS scores (p<0.05). Within-group correlation analyses revealed that as the CJPET error scores increased, static balance deteriorated in both groups. In the LTC group, hip muscle spasticity was found to increase, while in the HTC group, spasticity of the knee and ankle was increased. Additionally, as lower extremity proprioceptive awareness decreased, dynamic balance, particularly in the LTC group, was impaired, with increased MTS scores for the hip, knee, and ankle muscles (p<0.05). In the HTC group, static balance was notably impaired, but no significant changes were observed in MTS scores (p>0.05). This study indicates that high trunk control is one of the main factors for achieving high proprioceptive awareness, balance skills, spasticity management, and quality of life in stroke patients. It suggests that as trunk control deteriorates, cervical dyspiroceptivity is particularly associated with static balance impairment, while lower extremity dyspropriceptivity correlates with a shift from static to dynamic balance disturbances. Furthermore, lower extremity dyspiroceptivity are associated with spasticity that becomes more pronounced distally. Keywords: Balance, Stroke, Proprioception, Spasticity, Quality of Life