Moeyersons, C., Embrechts, E., Omari, S. A., Vlieger, D. D., Hanssen, B., Firouzi, M., Degelaen, M., Jansen, B., & Swinnen, E. (2025). Anticipatory postural adjustments after stroke: characteristics and influencing factors – a systematic review. Gait & Posture, 121. https://doi.org/10.1016/j.gaitpost.2025.07.160

@article{c7fa1e0469654335a771eedec9c0d8e8,
title = "Anticipatory postural adjustments after stroke: characteristics and influencing factors – a systematic review",
abstract = "Introduction: Anticipatory postural adjustments (APAs) are crucial for maintaining balance by preparing the body in advance of voluntary movement. These predictive, feedforward mechanisms stabilize posture in anticipation of self-initiated motion. Following a stroke, APAs are often impaired, contributing to postural instability and an increased risk of falls (1). Although APAs are vital for functional recovery, their characteristics across different tasks and the factors influencing their performance in stroke survivors remain insufficiently understood (2). Research Question: How are APAs characterized in stroke survivors during various functional tasks, and which key factors influence their generation and execution? Methods: A systematic search was conducted in PubMed and Web of Science up to December 2024, following PRISMA guidelines. Studies were included if they involved adults with stroke performing functional motor tasks (e.g., gait initiation, sit-to-stand, reaching) and reported quantitative APA-related measures (e.g., muscle activation, center of pressure [CoP] displacement). Only clinical trials, cohort, and observational studies in English, Dutch, or French were considered. Results: Twenty-nine studies met the inclusion criteria. APAs were assessed using electromyography, force plates, motion capture, and accelerometry during tasks such as reaching, walking, and transitional movements. However, considerable heterogeneity existed in study protocols, including variations in functional tasks, measurement tools, and outcome definitions. Compared to controls, stroke survivors showed delayed muscle activation, reduced APA amplitude, prolonged APA duration, and impaired CoP displacements. Deficits were observed bilaterally, particularly in trunk and lower limb muscles. The presence and quality of APAs were modulated by factors such as motor impairment severity, stroke chronicity, lesion location, and task complexity. APA impairments were more pronounced during complex or dynamic tasks and when using the affected limb. Compensatory strategies involving the non-affected limb and trunk were commonly observed. Interventions such as external attentional focus, neuromuscular training, and functional electrical stimulation improved APA timing and magnitude in some studies. Discussion: This review highlights that stroke significantly alters the generation and execution of APAs across various functional tasks, with impairments affecting multiple APA dimensions including timing, amplitude, and coordination. These deficits are influenced by both individual and task-related factors and may evolve over time. The findings underscore the importance of targeted rehabilitation strategies that address APA-specific deficits to enhance motor recovery and functional independence in stroke survivors. Future research should focus on the development of standardized assessment protocols, longitudinal tracking of APA recovery, and the optimization of interventions tailored to individual patient profiles. References: (1) Delafontaine, A., Vialleron, T., Hussein, T., Yiou, E., Honeine, J.-L., & Colnaghi, S. (2019). Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients [Systematic Review]. Frontiers in Neurology, Volume 10 - 2019. https://doi.org/10.3389/fneur.2019.00352 (2) Tomita, Y., Mullick, A. A., Feldman, A. G., & Levin, M. F. (2024). Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabilitation and Neural Repair, 38(3), 176-186. https://doi.org/10.1177/15459683241231528",
keywords = "accelerometry, adult, anticipation, body position, cerebrovascular accident, chronicity, conference abstract, duration, electromyogram, electromyography, fall risk, female, functional electrical stimulation, human, leg muscle, motion capture, motor dysfunction, neurorehabilitation, observational study, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, stroke patient, stroke survivor, systematic review, voluntary movement, walking",
author = "Charlotte Moeyersons and Elissa Embrechts and Omari, {Sarah Al} and Vlieger, {Daan De} and Britta Hanssen and Mahyar Firouzi and Marc Degelaen and Bart Jansen and Eva Swinnen",
year = "2025",
month = aug,
day = "1",
doi = "10.1016/j.gaitpost.2025.07.160",
language = "English",
volume = "121",
journal = "Gait & Posture",
issn = "0966-6362",
publisher = "Elsevier",
}