偏瘫患者站姿平衡和负重与鞋坡度及高度的相关性

目的 确定鞋的坡度和高度对偏瘫患者站姿平衡和负重的影响。方法 测量偏瘫患者在安静站立状态下及被迫体位转换时的重力支撑的关系。参加者：为康复医院的9例急性期一侧脑卒中后偏瘫的住院患者，要求在无协助或休患的情况下自E够独自站立3—5min，同时符合其他包括的标准。干预：在调整鞋的不同坡度(5&;#176;，7．5&;#176;，2．5&;#176;)和不同高度(0．6，0．9，1．2cm)的情况下，要求患者做体位转动，其重力支撑对称得分用来表示站姿平衡的特征。主要结果测量：重力支撑对称得分。结果在不提高鞋的高坡度时，偏瘫一侧肢体对称负重能力低[负载体重的(39．9&;#177;0．80)％]。如在患侧肢升高鞋底的高度和坡度，当人体位转动时，可以促进站姿平衡和负重的改善。倘若鞋的坡度为5&;#176;时，体质量的分配最平衡[人体质量的(51．4&;#177;1．1)％]。结论 要改善双脚站立时的平衡水平，建议应用调整患侧肢体鞋的高坡度，帮助患者克服患肢失用后的锻炼困难，从而保持运动时的身位平衡。     

脑卒中偏瘫患者步态的不对称性与平衡功能的相关性研究

目的研究脑卒中偏瘫患者步态时空参数的不对称性与平衡功能之间的相关性。 方法选取可以独立步行10m以上的单侧偏瘫的脑卒中患者30例设为病例组,相匹配的健康中老年人30例设为对照组,采用步态与平衡功能训练评估系统（AL-600型）对受试对象进行步态测试,经分析评估软件提取各步态时空参数（站立期时间、摆动期时间、步长及步宽）,其步态时空参数的不对称性评估用双侧下肢步长不对称比（SLA）、摆动期时间不对称比（SWTA）和站立期时间不对称比（STA）表示。并对30例脑卒中患者进行Berg平衡量表(BBS)评分。用两独立样本t检验分析病例组与对照组的各时空参数不对称比（SLA、SWTA、STA）及步宽的差异,用Pearson相关性分析法分析SLA、SWTA和STA分别与步宽及BBS评分之间的相关程度。 结果病例组患者步行时,患侧的步长及摆动期时间均较健侧增加(P<0.05),患侧站立期时间较健侧缩短（P<0.05）;而对照组下肢步态分析,各时空参数左右侧之间差异无统计学意义（P&rt;0.05）。病例组患者的步宽及各时空参数不对称比（SLA、SWTA和STA）的比值均较对照组增大（P<0.01）。病例组患者的步宽［(15.90±2.60）cm］与BBS评分［（41.57±7.27）分］之间呈中度负相关（r=-0.564,P<0.01）,而患者的SLA与步宽呈轻度正相关（r=0.432,P<0.05）,与BBS评分呈高度负相关（r=-0.849,P<0.01）;患者SWTA与步宽呈高度正相关（r=0.726,P<0.01）,与BBS评分呈中度负相关（r=-0.630,P<0.01）;患者STA与步宽和BBS评分之间均未见明显相关性（r=0.352,r=-0.126,P&rt;0.05）。 结论脑卒中偏瘫患者步态时空参数存在不对称性,其步态的不对称程度与平衡功能之间存在一定的相关性。     

脑卒中偏瘫患者步态与站立平衡功能间的相关性研究

目的 研究脑卒中偏瘫患者站立平衡功能与步行能力的相关性。 方法 选取可独立步行10m以上的脑卒中偏瘫患者88例并将其纳入患者组,同时选取相匹配的健康老年人纳入对照组。采用AL-600型步态与平衡功能训练评估系统对2组受试对象进行站立平衡功能及步态测试,步态检测指标包括步宽、步速、双下肢步长不对称比（SLA）、摆动期时间不对称比（SWTA）及站立期时间不对称比（STA）,平衡功能检测指标包括足底压力中心总轨迹长（COPD）、足底压力中心在左右方向的平均偏移（COPD-X）、足底压力中心在前后方向的平均偏移(COPD-Y)。采用t检验比较2组对象步态及平衡指标间差异,同时采用Pearson检验分析2组对象步态与平衡参数间的相关性。 结果 患者组对象步宽［（14.45±4.17）cm］、COPD［（66.75±29.04）cm］、COPD-X［（2.04±1.41）cm］、COPD-Y［（2.48±1.28）cm］、SLA（1.30±0.46）、SWTA（1.65±0.67）及STA（1.18±0.16）均较对照组明显增加（P<0.05）,步速［(37.64±18.29)cm/s］则较对照组明显减小（P<0.05）;患者组对象COPD-X与步速、步宽、SLA、SWTA呈轻度至中度相关（P<0.05）;COPD-Y与步宽呈轻度相关（P<0.05）。 结论 脑卒中偏瘫患者其站立平衡功能与步宽、步速、步态时空不对称参数间具有相关性,并且以左右方向平衡功能指标(如COPD-X)与步态参数间的相关性较为显著。     

偏瘫患者下肢运动功能、平衡功能和步行速度的相关性

目的 探讨偏瘫患者步行能力，平衡功能，下肢运动功能的相关性。方法 用计算机运动分析系统算出步行速度，用ＢＢＳ评定平衡功能，用Ｃｈｅｄｏｋｅ－ＭｃＭａｓｔｅｒ中风评测量表评定患侧下肢运动功能等级。结果 偏瘫患者的步行速度，平衡功能，患侧下肢运动功能恢复等级三者之间中度至高度正相关（ｒ＝０．６１０～０．７８８，Ｐ〈０．０１）。结论 在偏瘫患者的康复训练中，步行训练，平衡功能的训练和患者下肢运动功能的训     

平衡反馈训练仪与Berg平衡量表在评定脑卒中偏瘫患者平衡功能中的相关性

目的:探索平衡反馈训练仪与Berg平衡量表在评定脑卒中偏瘫患者平衡功能的相关性。方法:脑卒中偏瘫患者30例,分别进行Pro-Kin平衡仪站立位睁、闭眼静态平衡测试和Berg平衡评估,比较睁、闭眼时平衡仪检测指标重心摆动轨迹长和摆动面积的差异,并分别与Berg平衡量表评分进行Pearson相关性分析。结果:睁眼时重心摆动轨迹长及摆动面积与闭眼时比较,差异均有显著性(P<0.05)。睁眼时重心摆动轨迹长、摆动面积与BBS总分、第6、9项呈中度负相关(r=-0.408—-0.663,P<0.05);重心摆动轨迹长与第8、11—14项,摆动面积与第1、5、7呈中度负相关(r=-0.409—-0.590,P<0.05)。闭眼时摆动面积与第7、8项呈中度负相关(r=-0.492,-0.501,P<0.05);重心摆动轨迹长与Berg总分及子项都不相关。结论:Pro-Kin平衡仪的站立位静态平衡测试时睁眼重心摆动的重心摆动轨迹长及摆动面积可反映脑卒中偏瘫患者的静态平衡能力。     

静态平衡仪及平衡功能量表在偏瘫患者平衡功能评定中的应用及相关性分析

目的 探讨静态平衡仪及平衡功能量表在评定脑卒中偏瘫患者平衡功能时的特点及相关性.方法 共选取脑卒中偏瘫患者70例,将其纳入病例组,同期选取36例健康志愿者纳入对照组.由专人采用Berg平衡量表(BBS)、Fugl-Meyer平衡量表(FM-B)及Tetrax静态平衡仪对每位受试者平衡功能进行评定.结果 2组对象BBS、FM-B各项测试指标组间差异均有统计学意义(P＜0.05);对各组对象静态平衡仪检测数据分析后发现,病例组稳定性系数(SI)、体重分布系数(WDI)与对照组间差异具有统计学意义(P＜0.05);量表评定结果与静态平衡仪检测结果间具有显著相关性,其中BBS的静态总分与SI、WDI具有高度相关性.结论 量表评定及静态平衡仪检测均可真实反映偏瘫患者平衡功能,其中静态平衡仪能量化反映患者站立位平衡功能,而量表法简单、易行,在临床使用时应注意合理选择.

Abstract：

Objective To compare balance assessment with static balance measuring equipment and clinical balance measuring scales. Methods Seventy hemiplegic stroke patients ( the patient group) and 36 healthy volunteers (the controls) were recruited. Each subject's equilibrium was measured using the Berg Balance Scale (BBS) ,the Fugl-Meyer Balance Scale (FM-B) and tetra-ataxiametry, all by the same therapist. Results The BBS and FM-B results both showed significant differences between the patient group and the control group. The data obtained through tetra-ataxiametric assessment showed that the average weight distribution index ( WDI ) and stability index (SI) were significantly lower in the patient group than among the controls. There was a strong correlation between the tetra-ataxiametric assessment results and the clinical balance test outcomes. The WDI and SI from tetra-ataxiametry were strongly correlated with Berg total static scores. Conclusions Tetra-ataxiametry and the BBS and FM-B tests can all effectively reflect the equilibrium of stroke patients. Tetra-ataxiametry can measure balance ability quantitatively, while the clinical balance tests ( BBS, FM-B) are easier to conduct.     

上肢位及椅子高度对脑卒中偏瘫患者坐-站转移时下肢负重及稳定性的影响

目的：探讨上肢位及椅子高度对脑卒中偏瘫患者坐-站转移下肢负重及稳定性的影响。方法：脑卒中偏瘫患者30例,分别在双手叉握（GA）及双手交叉胸前（CA）两种上肢位及两种不同高度的椅子（高椅及标准椅）上完成坐-站转移测试,采用AL-080型步态与平衡功能训练评估系统对受试者完成坐-站转移的时间、双下肢负重、双下肢负重不对称性（IOA）及人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量,探讨其不同差异。结果：姿势GA时,除坐-站转移所需的时间外,健足平均负重、患足平均负重、IOA及COGX与姿势CA相比较,差异均有统计学意义（P〈0.05）。在高椅子上完成坐-站转移时,与标准椅子相比较,健足平均负重、患足平均负重及IOA无明显差异,而坐-站转移所需时间以及COGX均差异有统计学意义（P〈0.05）。左侧脑卒中偏瘫与右侧偏瘫相比较,坐-站转移所需时间、患侧下肢负重、健侧下肢负重、IOA及COGX均无差异（P〈0.05）。结论：不同上肢位影响脑卒中偏瘫患者坐-站转移的下肢负重及稳定性;椅子高度影响脑卒中偏瘫患者坐-站转移的稳定性。     

脑卒中偏瘫痉挛期患者足底压力与平衡功能的相关性分析

目的：探讨脑卒中偏瘫痉挛期患者的足底压力分布和平衡功能特点及相关性。方法：2020年12月至2022年2月于本院康复科招募脑卒中偏瘫痉挛期患者40例（研究组）和健康中老年志愿者30例（对照组）。2组均进行静、动态的足底压力和睁、闭眼下的平衡功能测试,比较2组足底8个区域压力参数,分析研究组足底压力不对称性与平衡功能的相关程度。结果：研究组中,与非偏瘫侧比较,偏瘫侧静态和动态足跟内侧和外侧的足底压力均明显低于非偏瘫侧（P＜0.05）。与对照组比较,研究组偏瘫侧静态和动态足跟内侧和外侧的足底压力均明显低于对照组（P＜0.05）,动态拇趾足底压力明显低于对照组（P＜0.05）。研究组闭眼状态下平衡测试运动轨迹长度与动态足跟内侧压力差呈正相关（R=0.645,P＜0.05）,与动态足跟外侧压力差呈正相关（R=0.518,P＜0.05）。结论：脑卒中偏瘫痉挛期患者步行时足底压力呈现不对称性,足跟内外侧压力的不对称与平衡运动轨迹长度存在相关性。     

动态平衡仪与Berg量表用于评定偏瘫患者平衡功能的相关性分析

目的:探讨Pro-Kin Line动态平衡仪及Berg量表(BBS)在偏瘫患者平衡功能障碍评定中的应用价值及相关性.方法:选取脑卒中患者50例为实验组,健康志愿者41例纳入对照组.由治疗师用BBS及Pro-Kin Line动态平衡仪对受试者平衡功能进行评定,分析BBS和动态平衡仪所得结果的相关性.结果:两组受试者的平均轨迹误差(ATE)及各项稳定指数具有显著性意义(P＜0.05).偏瘫组BBS得分与ATE、各项稳定指数均呈负相关(-0.226--0.617,P＜0.05);同时ATE与各项稳定指数均呈正相关(0.392-0.813,P＜0.05),其中ATE与圆周稳定指数呈高度正相关(r=0.813,P＜0.01).结论:Berg量表和动态平衡仪测试均可反映偏瘫患者平衡功能且具有相关性,其中动态平衡仪较Berg量表更全面、详细、客观地反映患者的平衡功能.     

站立平衡训练对成人偏瘫患者平衡和运动的作用

<正> 成人脑血管意外导致偏瘫的患者在步行中典型的表现是体位向患肢转移相对受限,患肢单侧站立持续时间比健肢相应地要短一些。加之健肢代偿性控制的改变,这些不对称性被进一步加重。对于这种双侧性运动异常,一般的观点是通过增强双下肢间重心转移能力的训练,以改善步型的不对称性和提高其有效性。对中风患者的一些运动再训练方案就是根据这个观点而设计的。虽然已有许多站立平衡研究提示加强重心转移活动的运动再训练方案改善了静态站立的对称性,但     

The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals

OBJECTIVE: To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. DESIGN: Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift. SETTING: Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS: Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria. INTERVENTIONS: Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance. MAIN OUTCOME MEASURES: Weight-bearing symmetry scores. RESULTS: Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight). CONCLUSION: Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.     

The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis

OBJECTIVE: To determine the effect of lifts to the shoe of the nonaffected leg on weight symmetry and dynamic posturography in individuals with hemiparesis. DESIGN: Quantitative posturography was performed to determine subjects' response to sudden perturbations. Subjects received graded forward and backward perturbations while standing on a movable force platform. Compelled shift of the body weight was induced with sized lifts to the shoe of the nonaffected leg. Balance responses were analyzed in terms of latency and strength of neuromuscular response. Symmetry scores were used to characterize the symmetry of stance. SETTING: Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS: Ten individuals with hemiparesis as a result of unilateral stroke. MAIN OUTCOME MEASURES: Weight symmetry scores, latencies of each leg's active response to the support surface translations, and response strength scores of each leg to the platform translations. RESULTS: When no lift was used, weight symmetry was characterized by underloading of the affected limb, as well as by longer onset latencies for the affected limb compared with the stronger one (158.5 +/- 3.9 vs 151.1 +/- 3.5 ms; p < .01 for large backward translations; 165.7 +/- 7.2 vs 158.0 +/- 5.1 ms; p < .01 for large forward translations). Response strength of the nonparetic limb was 2 times greater than the response strength of the weaker extremity (p < .05). Compelled weight shift induced by lifts applied to the shoe of the nonparetic limb promoted improved weight symmetry, shortened latencies, and increased magnitudes of the response strength. CONCLUSION: Lifts applied to the shoe of the stronger limb induced a body weight shift toward the paretic limb and resulted in improved symmetry of stance and postural control of individuals with hemiparesis. We suggest that compelled weight distribution induced by lifts to the shoe of the stronger limb could help treat ambulatory individuals with asymmetric stance and hemiparesis caused by unilateral stroke.     

The effects of dynamic ankle-foot orthoses on functional ambulation activities,weight bearing and spatio-temporal characteristics of hemiparetic gait

Purpose. To investigate the effects of dynamic ankle-foot orthoses (DAFOs) on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait and to inquire whether wearing a DAFO for 3 months has a carryover effect.

Method.?Fourteen chronic hemiparetic patients who could walk independently with or without a cane were the subjects of the study. Patients were assessed initially with tennis shoes and were given custom fabricated DAFOs which they wore for three months and were retested under two conditions: with tennis shoes only and with DAFOs worn in these shoes. All patients were assessed for weight bearing percentage of the affected side, cadence, step length of the involved and uninvolved sides, step width, functional reach, timed up and go, timed down stairs, timed up stairs, physiologic cost index and velocity.

Results.?Comparison of initial and third month assessments with shoes only condition showed that there was no significant improvement for the measured parameters. When comparison was made at the third month while patients were wearing tennis shoes only and when they were wearing DAFO's in their shoes there was a significant difference in favour of the condition where patients were wearing DAFOs.

Conclusion.?The benefits of using DAFOs in chronic hemiparetic patients are lost when the patients are not wearing their orthoses.     

Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients

OBJECTIVE: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients. DESIGN: Crossover design with randomized order of the intervention. SETTING: A rehabilitation centre for adults with neurological disorders. SUBJECTS: Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury. MEASURES: Postural sway, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone. RESULTS: AFO significantly improved weight-bearing on the affected leg (affected/ unaffected side symmetry: 2.25 +/- 1.5 with AFO versus 3.4 +/- 2.5 without AFO, P<0.05) and postural sway in stance (12.5 mm +/- 5.2 with AFO versus 15.7 mm +/- 6.7 without AFO, P < 0.05), double stance duration (21.1 +/-14.4% of gait cycle with AFO versus 25.9 +/- 21.6% of gait cycle without AFO, P < 0.05), and symmetry ratios of gait parameters such as stance duration (2.0 +/- 1.5 s with AFO versus 3.3 +/- 3.6 s without AFO, P < 0.05) and deceleration forces (1.6 +/- 0.5 with AFO versus 1.9 +/- 0.6 without AFO, P < 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters. CONCLUSION: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.     

Influence of weight bearing visual feedback on movement symmetry during sit to stand task

BackgroundWeight-bearing asymmetry is common in individuals with hip osteoarthritis and after total hip arthroplasty. Including symmetry training to the rehabilitation programs may normalize movement strategies during dynamic tasks. The purpose of this study was to evaluate the immediate influences of real-time visual feedback of weight distribution on the interlimb movement symmetry during the sit-to-stand task, before and after total hip arthroplasty, and to determine whether physical impairments affect the response to visual feedback.MethodsSubjects before and after total hip arthroplasty participated in three- dimensional motion analysis. Subjects completed 3 trials of sit-to-stand task in two conditions; “without visual feedback” and “with visual feedback”. Outcome measures were the interlimb symmetry of vertical ground reaction force, and joint kinematics and kinetics. Pain and strength of lower limbs were assessed.FindingsCompared to “without visual feedback” condition, subjects moved with greater symmetry of vertical ground reaction force and joint kinetics when visual feedback was received. However, subjects continued to demonstrate interlimb difference for joint kinetics and vertical ground reaction force in the visual feedback condition. The increase in symmetry was not strongly influenced by physical impairments and subjects before and after total hip arthroplasty responded similarly to the feedback.InterpretationsWe concluded that in a single session, the visual feedback of weight bearing distribution had a positive immediate effect on movement symmetry during the sit-to-stand task. Future studies that assess long-term retention and functional benefits are warranted before visual feedback is incorporated in rehabilitation for this patient population.     

Effect of heel lifts in elderly individuals with spinal kyphosis

BackgroundThe present study aimed to elucidate the effects of heel lifts on spinal alignment, walking, and foot pressure pattern in elderly individuals with spinal kyphosis.MethodsThe spinal alignment, walking speed, step length and foot pressure of 33 community-dwelling elderly individuals with spinal kyphosis (3 men, 30 women; mean age 77.3 years) were examined before and after the application of 10-mm moderately elastic heel lifts.FindingsSpinal alignment of total inclination (mean value 6.9°vs 4.5°) and thoracic angle (43.6°vs 36.2°) were significantly lower after the application of heel lifts than before the application. The lumbar angle (7.3°vs 10.0°) was significantly higher after the application than before the application. Walking speed (0.78 vs 0.88 m/s) and step length (0.42 m vs 0.45 m) were significantly higher after the application. The partial foot pressure as a percentage of body weight of the hallux (6.7% vs 9.0%) and lateral toes (6.5% vs 9.0%) was significantly higher after the application of heel lifts than before the application. The partial foot pressure as a percentage of body weight of the heel (68.9% vs 57.5%) was significantly lower after the application than before the application.InterpretationIn conclusion, heel lifts influenced the sagittal spinal alignment of elderly individuals. Walking speed and step length increased after the application of these devices. Increase in foot pressure in the hallux and lateral toe areas was probably related to these improvements in walking parameters.     

The effect of immediate decreasing of weight bearing asymmetry on quiet standing postural control in individuals with chronic stroke

The main patterns characterizing standing posture of hemiparetic patients include: weight-bearing asymmetry (WBA), larger postural sway, asymmetrical contribution of lower limbs to balance control, and increased visual dependency to balance control. The aim of this study was to evaluate the effect of decreasing WBA with the use of a shoe lift, on quiet standing postural control in patients with chronic stroke. Twenty-seven patients participated in this study. Patients completed two tests: 1) quiet standing; and 2) quiet standing while a lift was placed under the non-paretic limb. The following tests were completed on force plates for evaluation: asymmetry of the balance measures (weight bearing, root mean square (RMS) of anterior-posterior (AP) and medial-lateral (ML) center of pressure (COP) velocity), RMS of total AP and ML COP velocity, and AP and ML Romberg quotients. Paired t-tests were used to analyze the data. The mean value of WBA index decreased significantly after using a lift (p < 0.05). However, the changes of the mean value of other postural control parameters were not significant (p > 0.05). The results indicate that there may not be an association between decreased WBA and improved postural control during quiet standing in patients with stroke.     

Comparison of strength measurements under single-joint and multi-joint conditions in hemiparetic individuals

OBJECTIVE: It has been suggested that the measurement of strength is inappropriate in patients with stroke, in large part because of the presence of abnormal synergy patterns. The aim of the present study was to characterize force production during multi-joint maximal exertion involving different combinations of activation between shoulder and elbow flexors and extensors. DESIGN: Cross-sectional study. SETTING: Rehabilitation centre. SUBJECTS: A convenience sample of 16 chronic hemiparetic stroke subjects. MAIN OUTCOME MEASURES: Maximal torques in flexion and extension at the shoulder and the elbow were measured using static dynamometers (single-joint condition). In addition, the maximal forces produced at the wrist were measured in four directions in the sagittal plane requiring different torque combinations between shoulder and elbow flexors and extensors (multi-joint condition). RESULTS: No difference was found across directions for the ratios of maximal forces (paretic/nonparetic) in the multi-joint condition (p = 0.227; mean ratios (+/- SD) for each direction ranging from 0.59+/-0.23 to 0.68+/-0.27), suggesting that the ability to produce force did not change as a function of the required torque combination. In addition, relative torques (% of the maximal torque in the single-joint condition) exerted during the multi-joint exertions were similar on the paretic and the nonparetic side. CONCLUSIONS: These results do not support the assumption that force production is limited by abnormal synergy patterns between flexors and extensors at the shoulder and the elbow in hemiparetic patients.