Clinical Biomechanics 22 (2007) 1024–1029

www.elsevier.com/locate/clinbiomech

Biomechanical assessment of the sitting posture maintenance

in patients with stroke
a,*
N. Genthon , N. Vuillerme a, J.P. Monnet b, C. Petit c, P. Rougier a

a
Département STAPS, Université de Savoie, Domaine Universitaire de Savoie-Technolac, 73 376 Le Bourget du Lac Cedex, France
b
IUP Sport Kinesithérapie et Santé, Ecole de Kinésithérapie du CHU de Grenoble, 38130 Echirolles, France
c
Centre Hospitalier Régional, 1 Avenue de Trésum 74000 Annecy, France

Received 17 October 2006; accepted 18 July 2007

Abstract

Background and purpose. Regaining control of sitting posture is one of the first goals in the rehabilitation of patients with stroke. So, it
requires a precise quantification of this postural behaviour. The purpose of the present investigation was thus to assess postural control
during sitting in people with hemiparesis through a biomechanical analysis.
Methods. Centre-of-pressure displacements were recorded by means of a force platform on which 10 patients with stroke and 10
age-matched healthy subjects were sitting. Centre-of-pressure trajectories were processed through space-time and frequency analyses.
Results. These centre-of-pressure displacements of the patients with stroke were characterised by an increased control for maintaining
sit position and by reduced postural performance, as enlightened by the larger surfaces covered by the centre-of-pressure displacements
(P < .05) and increased velocities (P < .001), respectively. As shown from the frequency analysis, the impairment have affected predom-
inantly the displacements occurring along the antero-posterior axis (P < .05).
Interpretations. The analysis of centre-of-pressure displacements during sitting posture indicates an increased postural disturbance in
patients with stroke. A platform device, because of the non-invasive, easy and fast measures carried out, should thus be viewed as an
attractive tool for assessing the postural dysfunctioning encountered in sat patients with stroke. This tool could also be used for
evaluating, the rehabilitation process following stroke.
Ó 2007 Published by Elsevier Ltd.

Keywords: Hemiparetic; Sitting posture; Postural control; Centre-of-pressure; Force platform

1. Introduction observed (Bertrand and Bourbonnais, 2001; Bohannon

Trunk muscles are mostly involved in the construction
of sitting posture and then in those of more complex abil-
ities such as reaching, upright standing or walking. Follow-
ing stroke, it is generally accepted that the control of trunk
muscle is severely impaired (Bohannon et al., 1995; Davies,
1990; Olney and Martin, 1997). More precisely, even
though the loss of muscular strength is larger for the pare-
tic side in comparison to the non-paretic one, a lower iso-
metric strength in bilateral trunk muscles is however
*
Corresponding author.
E-mail address: nicolas.genthon@univ-savoie.fr (N. Genthon).
et al., 1995; Gauthier et al., 1992). Also, patients are gener-
ally characterised by a controlateral somatosensorial defi-
ciency, inducing a dysfunctioning in the construction of
the body scheme (Perennou et al., 1998), an hemianopsia
and some reorganisation on the sensory collection strategy
(Bonan et al., 2004; Di Fabio and Badke, 1990).
As a consequence, independent sitting of patients with
stroke is generally disturbed. For instance, a prospective
study involving 93 patients (Mayo et al., 1991) has shown
that 48% and 27% of the patients with stroke were unable
to sit independently at the onset and the end of the rehabil-
itation process, respectively. These dysfunctions are sug-
gested to be caused by some perceptual impairments
(Mayo et al., 1991) and motor loss (Franchignoni et al.,

0268-0033/$ - see front matter Ó 2007 Published by Elsevier Ltd.

doi:10.1016/j.clinbiomech.2007.07.011
 N. Genthon et al. / Clinical Biomechanics 22 (2007) 1024–1029
1997; Hsieh et al., 2002). Due to the importance of trunk
control in more complex abilities, restoration of sitting pos-
ture appears determinant for recovering independent func-
tions (Franchignoni et al., 1997; Hsieh et al., 2002; Wade
et al., 1983). In other words, the observation of decreased
sitting postural control capacities at an earlier stage follow-
ing stroke is generally associated with a poor subsequent
functional recovery. Consequently, sitting postural control
must be one of the main goals in the rehabilitation process
following stroke and needs to be accurately investigated.
Following stroke, functional evaluation of the trunk
function or of independent sitting is classically performed
through clinical evaluations such as the capacity to main-
tain the sitting posture for a few seconds without falling
(Bohannon et al., 1986) or through a clinical scale, such
as the trunk control test (TCT) (Franchignoni et al.,
1997; Hsieh et al., 2002), the postural assessment scale
for stroke (PASS) (Benaim et al., 1999; Hsieh et al.,
2002), or the Fugl-Meyer test (Fugl-Meyer et al., 1975;
Hsieh et al., 2002). These procedures underline the major
impairments characterising both static and dynamic sitting
behaviours resulting from stroke. On the other hand, these
methods can be operator dependent, and necessitate an
apprenticeship. Another flaw of such methods lies in the
impossibility to quantify precisely the postural behaviour
during undisturbed sitting posture (Sandin and Smith,
1990), which is the necessary ability for building more com-
plex tasks such as reaching, standing still upright or walk-
ing. The classical method used to assess the amount of
postural sway encountered in undisturbed upright stance
has, for many decades, consisted in measuring, using a
force platform, the trajectories of the centre-of-pressure
(CoP), i.e. the successive points of application of the resul-
tant ground reaction forces. Interestingly, a force platform
furnishes interesting insights for evaluating upright stance
of both healthy subjects and people with stroke (Geurts
et al., 2005; Mizrahi et al., 1989; Shumway-Cook et al.,
1988).
Upright standing and sitting position maintenance are
both closed tasks. Even though the biomechanical con-
straints applied to the human body structure are slightly
different, these two tasks share many features such as coun-
teracting gravity and preparing the body to move. These
objectives could be achieved by using different sensory cues
(somatosensorial, visual, and labyrinthic), integrated at dif-
ferent central levels (spinal and cortical). Differences
between upright and sitting postures concern principally:
the localisation of cutaneous inputs (principally collected
from the feet in upright standing and from buttock in sit-
ting position), the number of segments and the type of seg-
ment to be controlled (lower and upper limb muscles in
upright and sit positions, respectively).
The purpose of the present investigation was thus to
quantify postural control during sitting in people with
stroke through a biomechanical analysis generally used to
assess upright undisturbed stance. Accordingly, CoP dis-
placements were recorded during quiet sitting with a force
1025
platform. In parallel, a group of matched young healthy
subjects was also tested. Due to the major sensory and
motor impairments characterising the patients with stroke,
it was thus hypothesised that hemiparetics would exhibit a
decreased postural control during sitting as compared to
the control group. This impairment should be characterised
by increased displacements and velocities of the CoP. Fur-
thermore, given the importance of muscular force loss in
the trunk flexor/extensor muscles following stroke (Bohan-
non et al., 1995), discrepancies in the induced effects
according to the frontal and sagittal planes could be
expected consisting in a decreased postural control occur-
ring mainly along the AP axis.
2. Methods
2.1. Subjects
Patients and healthy subjects enrolled in the study gave
informed consent prior the study. Ten patients with hemi-
paresis who had suffered a first stroke and 10 healthy sub-
jects, of similar age, took part in the study. The patients
were admitted to the hospital for rehabilitation and met
the following criteria: (1) adults of more 55, (2) stroke of
less than 3 months, (3) medical stability, (4) ability to stand
sit without back support over 40 s, (5) ability to understand
instructions and to execute them adequately. Patients with
(1) psychiatric disorders or dementia, (2) orthopaedic dis-
eases that could affect balance were excluded. The present
study was conducted with a mean time delay of 19.8 (SD:
9.9) days after stroke. Summary of clinical data are given
through Table 1.
2.2. Task and procedure
CoP displacements were measured by an equilateral tri-
angular (each side = 80 cm) force platform (PF01, Equi+,
Aix les Bains, France) on which the subjects were sitting.
The platform was positioned on a rigid table border one
meter above the floor. The subjects sat directly on the plat-
form, back unsupported, feet not touching the ground,
popliteus hollows on the platform border, shanks and feet
hanging, arms crossed on the abdomen, and facing a white
wall 1.5 m in front of them (see Genthon and Rougier
Table 1
Summary of the characteristics for the control groups and patients with
stroke (mean (SD))
Patients with stroke, Healthy subjects, P
Mean (SD) Mean (SD)
Age (years) 71.1 (11.17) 68.0 (16.1) >.05
Weight (kg) 70.9 (7.7) 69.3 (11.5) >.05
Height (m) 1.70 (0.05) 1.67 (0.08) >.05
Sex (f/m) 5f, 5 m 4f, 6 m >.05
Lesion location 1l; 9r
(l/r)
The two groups are paired for the age, weight and height.
1026 N. Genthon et al. / Clinical Biomechanics 22 (2007) 1024–1029

(2006) for an illustration of the positioning). Patients were 3. Results

evaluated during five successive trials each lasting 32 s, dur-
ing which they were required to move as little as possible. 3.1. Space-time domain analysis
The rest periods between the trials lasted more than 1 min.
Representative CoP displacements obtained from a typ-
2.3. Signal processing ical control subject and a patients with stroke are illus-
trated through Fig. 1a. Patients with stroke exhibited
The ground reaction forces, issued from three vertical larger surface area covered by the CoP displacements
mono-axial dynamometric load cells (range: 0–50 daN), (U = 21, P < .05; Fig. 1b) and larger mean velocities
were simultaneously recorded with a 64 Hz frequency on (U = 6, P < .001; Fig. 1c) than the control subjects.
a personal computer during the tests (without any filter-
ing). The signals were then amplified and converted from
analogue to digital form through a 12 bits acquisition card, 3.2. Frequency domain
CoP displacements along medio-lateral (ML) and antero-
posterior (AP) axes were calculated from ground reaction A representative frequency decomposition of the CoP
forces. displacements obtained from a typical control subject and
At a first step, the planar CoP movements were ana- a patients with stroke is illustrated through Fig. 2a. In
lysed through a classical analysis including computations comparison to the control group, the RMS from the
of the surface area (Tagaki et al., 1985) and mean veloc- patients with stroke remained unchanged along the ML
ity. Temporal and spatial characteristics of the CoP axis (U = 36, P > .05; Fig. 2b), whereas larger values were
movements along the ML and AP axes were evaluated observed along the AP one (U = 23, P < .05; Fig. 2b). On
through a frequency analysis. This methodology offers dif- the other hand, RMS measured from ML and AP axes
ferent interests: (i) an independence of the evaluation were not different, this fact being noticed for both healthy
modalities and more precisely of the duration of the subjects and patients with stroke (T = 19, P > .05; T = 11,
acquisition. (ii) A characterisation of both CoP spatial P > .05; respectively).
and temporal characteristics along both ML and AP axes. No difference was observed between healthy subjects
This methodology consists, at a first step, to convert CoP and patients with stroke for the MPF for both ML and
movements in the frequency domain through a fast Fou- AP axes (U = 47, P > .05; U = 25, P > .05, respectively)
rier transform for obtaining the amplitude distribution as (Fig. 2c).
a function of the frequency. The frequency spectra were
then characterised, on a 0–3 Hz bandwidth, by some
parameters such as the root mean square (RMS) and
the mean power frequency (MPF). The former quantifies
the range of the movements independently of the fre-
quency whilst the latter represents its mean frequency,
i.e. the mean time for these movements to return to an
identical position
sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi ,
Pi¼k 2
i¼j Ai
X
i¼k X
i¼k
RMS ¼ MPF ¼ ðS i  Ai Þ Ai
k i¼j i¼j

where i represents the frequency class, j and k the range of

the frequency bandwidth, Ai the range of the class and Si its
median frequency.

2.4. Statistical analysis

For each dependant variable and each group, the mean

and standard deviation were computed. Data from both
control subjects and patients with stroke were compared
through a non-parametric statistical analysis based on
the ranks: the non-paired Mann–Whitney U-test. On the
other hand, the results for each subject along ML and
AP axes were assessed through a paired Wilcoxon T-test.
In both cases, the first level of significance was set at
P < .05.
Fig. 1. (a) Representative CoP displacements obtained from a typical
control subjects (black line) and patient with stroke (grey line). Note the
dispersion of the CoP movements of the patients with stroke in
comparison to those of the control subject. Means and standard
deviations of the surface area (b) and CoP velocity (c) characterising
healthy and patients with stroke CoP displacements. The statistically
significant values between patients with stroke and control group are
reported (*P < .05; ***P < .001).
 N. Genthon et al. / Clinical Biomechanics 22 (2007) 1024–1029 1027

Fig. 2. (a) Mean representative frequency decomposition of the CoP displacements along the ML and AP axes, for the control subjects (in black) and
hemiparetic patients (in grey). Left and right panels represent ML and AP axes, respectively. Means and standard deviations for the RMS (b) and MPF (c)
characterising control group and patients with stroke CoP spectra. The statistically significant values between patients with stroke and control group are
reported (*P < .05).

4. Discussion result of reduced co-contractions involving agonistic and

The purpose of the present study was to investigate the
sitting posture by using a system classically used for analy-
sing upright undisturbed stance: a force platform. In par-
ticular, this study was aimed to analyse biomechanically
the sitting posture following stroke through the CoP
displacements.
Until now, such a biomechanical analysis was mostly
used to assess undisturbed upright stance maintenance.
Upright stance is regulated by multiple sensory cues includ-
ing vision, vestibular, proprioceptive and tactile plantar
inputs. In undisturbed sitting position some sensory and
mechanical changes have to be emphasised. At a sensory
level, it is easy to see that both tactile plantar and leg soma-
tosensorial thresholds are ineffective in the sitting position
regulation whereas tactile buttock inputs are used. At a
motor level, centre of gravity height is reduced, the base
of support is larger and the number of joints to be con-
trolled is reduced. Sitting position is indeed principally con-
trolled by the trunk muscles mobilising the pelvic joints.
Despite of these differences, the control involved in sitting
position presents the same characteristics to those observed
in upright standing, suggesting that both sitting and
upright postures have similar mechanical characteristics
and/or are controlled by a same central behaviour (Gen-
thon and Rougier, 2006). Nevertheless, due to the reduced
biomechanical constraints, CoP magnitudes are smaller in
sitting position than in upright standing (Genthon and
Rougier, 2006). This feature could be interpreted as the
antagonistic muscles in sitting position stabilisation.
Concerning patients with stroke sitting behaviour, a lar-
ger disturbance, characterised by an increase of both CoP
areas and mean velocity, was observed in our patients
tested early after stroke (20 days), as compared to the
healthy ones. These results are in accordance with our
hypothesis and with previous studies on patients with
stroke sitting posture based on clinical scales. Whatever
the test used, TCT (Franchignoni et al., 1997; Hsieh
et al., 2002), PASS (Hsieh et al., 2002) or Fugl-Meyer
(Hsieh et al., 2002), patients with stroke exhibit some
minor scores, hence revealing some disability in trunk func-
tion (flexion/extension; adduction/abduction, transfer) and
in maintaining sitting position (dynamic and undisturbed).
The body scheme miss-representation (Perennou et al.,
1998) and the loss of force in the trunk musculature
(Bohannon et al., 1995; Davies, 1990; Olney and Martin,
1997) generally observed following stroke might easily
explain these impairments.
Interestingly, a biomechanical evaluation of undisturbed
sitting posture gives more insights than does the clinical
evaluation. In previous studies, the area covered by the
CoP excursion was considered as an indicator of postural
performance, defined by some reduced body oscillations.
Rigorously, this conception is not totally correct. CoP tra-
jectory is the net product of the muscular action developed
in order to controlled body stability. Postural stability
could be better quantified by the centre of gravity (CG)
movements, which express body sways. It is well known
1028 N. Genthon et al. / Clinical Biomechanics 22 (2007) 1024–1029
that CG movements are directly controlled by the CoP dis-
placements. If CoP frequency displacements remain
unchanged, enhanced CoP trajectories are already associ-
ated with enhanced CG movements (Breniere, 1996). In
our case, because the CoP frequency bandwidths of
patients with stroke and healthy subjects are similar,
enhanced CoP trajectories observed following stroke could
be interpreted as a reduced postural performance.
The mean velocity of CoP displacements for the sampled
period is generally considered as a postural activity index
(Geurts et al., 1993; Maki et al., 1990). It can be viewed
as representing the amount of activity required to maintain
a given posture. Along these lines, our tested patients with
stroke, which are characterised by enhanced CoP velocity,
would involve an increased activity to maintain finally a
more unstable sitting posture. Furthermore, it is admitted
that the stability limits of patients with stroke, which are
defined as the maximal CoP positioning that patients are
able to maintain without falling, are reduced during sitting
posture (Nichols et al., 1996). Moving the CoP faster near
these stability limits can thus be considered as an important
indicator of risk of falling (Pai and Patton, 1997).
More precisely, our frequency analysis reveals enhanced
CoP displacements along the AP axis 20 days following
stroke as compared to those along the ML one. These
results suggest that the sagittal equilibrium would be more
impaired than the frontal one. It could be interpreted as a
larger impairment in the bilateral antagonistic recruitment
of the rectus abdominis and latissimus dorsi muscles, prin-
cipally involved in the control of the flexion and extension
of the trunk, respectively, than in the bilateral antagonistic
recruitment of the left and right obliqus abdominus externi
and obliqus abdominus interni, which are principally
involved in the control of lateral trunk motions (Zedka
et al., 1998). This feature is in accordance with a previous
work of Bohannon et al. (1995) which had shown a multi-
directional loss of trunk musculature force following
stroke, even though this loss was more marked in the trunk
flexion.
Thus, a force platform device should be viewed as an
interesting tool for a better understanding of sitting posture
impairment following stroke.
By using pertinent parameters, it allows us to under-
stand specific components of postural control: the perfor-
mance (sway area) and the activity (mean velocity) used
to maintain sitting position. What is more, by dissociating
the movements occurring along ML and AP axes, the defi-
ciency intervening in the anterior and posterior trunk mus-
cles can be dissociated from those involving the lateral
trunk muscular groups. In order to evaluate objectively a
patient or a rehabilitation protocol, some precise parame-
ters aimed at characterising the sitting posture behaviour
can be extracted. These parameters permits to better under-
stand the origins of the postural trouble of patients with
stroke and are largely more reproducible and objective
than standard clinical evaluation scales. On the other hand,
since it has been reported that 48% of the patients with
stroke are not able to sit independently at the time of
admission in a rehabilitation centre (Mayo et al., 1991),
an important limit of this methodology is the time (40 s)
the patients have to maintain their sitting posture alone.
Consequently, this methodology would be inappropriate
for evaluating the more severed impaired patients or at
the earlier period following stroke. Recourse in parallel
of both a clinical evaluation, for the more impaired
patients, and biomechanical measures, for the patients able
to sit independently, appears thus necessary.
5. Conclusion
This study has clearly assessed one postural impair-
ments characterising patients with stroke when maintain-
ing undisturbed sitting. Theses impairments include both
velocity and magnitude of postural regulations. These
facts have been interpreted by an enhancement of the
amount activity associated by a reduction of the postural
performance of patients with stroke during sit mainte-
nance. In addition, some major impairments are noted
on the sagittal plane, likely due to the major loss of mus-
cular control intervening on the trunk flexor/extensor
muscles. Since interesting and precise parameters can be
given early (as soon as 20 days for our patients), a force
platform system appears pertinent for evaluating the reha-
bilitation process following stroke. For instance, the short
and long terms effects on such posture of rehabilitation
techniques based on feedback techniques (mirror or CoP
feedback from a computer) could be easily evaluated with
this device.
Acknowledgements
The authors want to thank the geriatric team of Cham-
béry hospital (France), particularly Dr. C. Hohn, for their
contribution to this research, Dr. L. Berger for her help in
healthy subjects’ recruitment, and D. Goodhew for correct-
ing the text.
References
Benaim, C., Perennou, D.A., Villy, J., Rousseaux, M., Pelissier, J.Y.,
1999. Validation of a standardized assessment of postural control in
stroke patients: the postural assessment scale for stroke patients
(PASS). Stroke 30, 1862–1868.
Bertrand, A.M., Bourbonnais, D., 2001. Effects of upper limb unilateral
isometric efforts on postural stabilization in subjects with hemiparesis.
Arch. Phys. Med. Rehabil. 82, 403–411.
Bohannon, R.W., Smith, M.B., Larkin, P.A., 1986. Relationship between
independent sitting balance and side of hemiparesis. Phys. Ther. 66,
944–945.
Bohannon, R.W., 1995. Recovery and correlates of trunk muscle strength
after stroke. Int. J. Rehabil. Res. 18, 162–167.
Bonan, I.V., Colle, F.M., Guichard, J.P., Vicaut, E., Eisenfisz, M., Tran
Ba Huy, P., Yelnik, A.P., 2004. Reliance on visual information after
stroke. Part I. Balance on dynamic posturography. Arch. Phys. Med.
Rehabil. 85, 268–273.
Breniere, Y., 1996. Why we walk the way we do. J. Mot. Behav. 28, 291–
298.
 N. Genthon et al. / Clinical Biomechanics 22 (2007) 1024–1029
Davies, P.M., 1990. Right in the middle-selective trunk activity in the
treatment of adult hemiplegia. In: Journal. Springer-Verlag, Berlin.
Di Fabio, R.P., Badke, M.B., 1990. Relationship of sensory organization
to balance function in patients with hemiplegia. Phys. Ther. 70, 542–
548.
Franchignoni, F.P., Tesio, L., Ricupero, C., Martino, M.T., 1997. Trunk
control test as an early predictor of stroke rehabilitation outcome.
Stroke 28, 1382–1385.
Fugl-Meyer, A.R., Jaasko, L., Leyman, I., Olsson, S., Steglind, S., 1975.
The post-stroke hemiplegic patient. Part 1. A method for evaluation of
physical performance. Scand. J. Rehabil. Med. 7, 13–31.
Gauthier, J., Bourbonnais, D., Filiatrault, J., Gravel, D., Arsenault, A.B.,
1992. Characterization of contralateral torques during static hip efforts
in healthy subjects and subjects with hemiparesis. Brain 115, 1193–
1207.
Genthon, N., Rougier, P., 2006. Does the capacity to approprately
stabilize trunk movements facilitate the control of upright standing?
Motor Control 10, 232–243.
Geurts, A.C., Nienhuis, B., Mulder, T.W., 1993. Intrasubject variability of
selected force-platform parameters in the quantification of postural
control. Arch. Phys. Med. Rehabil. 74, 1144–1150.
Geurts, A.C., Haart, M., Van Ness, I., Duyssens, J., 2005. A review of
standing balance recovery from stroke. Gait Posture 22, 267–281.
Hsieh, C.L., Sheu, C.F., Hsueh, I.P., Wang, C.H., 2002. Trunk control as
an early predictor of comprehensive activities of daily living function
in stroke patients. Stroke 33, 2626–2630.
Maki, B.E., Holliday, P.J., Fernie, G.R., 1990. Aging and postural
control. A comparison of spontaneous- and induced-sway balance
tests. J. Am. Geriatr. Soc. 38, 1–9.
Mayo, N.E., Korner-Bitensky, N.A., Becker, R., 1991. Recovery time of
independent function post-stroke. Am. J. Phys. Med. Rehabil. 70, 5–12.
1029
Mizrahi, J., Solzi, P., Ring, H., Nisell, R., 1989. Postural stability in stroke
patients: vectorial expression of asymmetry, sway activity and relative
sequence of reactive forces. Med. Biol. Eng. Comput. 27, 181–190.
Nichols, D.S., Miller, L., Colby, L.A., Pease, W.S., 1996. Sitting balance:
its relation to function in individuals with hemiparesis. Arch. Phys.
Med. Rehabil. 77, 865–869.
Olney, S.J., Martin, C.S., 1997. Rehabilitation: physical therapy for
stroke. In: Welch, K.M.A., Caplan, L.R., Reiss, D.J. (Eds.), Primer on
Cerebrovascular Diseases. Academic Press, San Diego, CA, pp. 747–
751.
Pai, Y.C., Patton, J., 1997. Center of mass velocity-position predictions
for balance control. J. Biomech. 30, 347–354.
Perennou, D.A., Amblard, B., Leblond, C., Pelissier, J., 1998. Biased
postural vertical in humans with hemispheric cerebral lesions. Neuro-
sci. Lett. 252, 75–78.
Sandin, K.J., Smith, B.S., 1990. The measure of balance in sitting in stroke
rehabilitation prognosis. Stroke 21, 82–86.
Shumway-Cook, A., Anson, D., Haller, S., 1988. Postural sway biofeed-
back: its effect on reestablishing stance stability in hemiplegic patients.
Arch. Phys. Med. Rehabil. 69, 395–400.
Tagaki, A., Fujimura, E., Sueshiro, S., 1985. A new method of
statokinesigram area measurement. Application and statistically cal-
culated ellipse. In: Black, O., Igarashi, M. (Eds.), Vestibular and Visual
Control on Posture and Locomotor Equilibrium. Karger, Bâle, pp. 74–
79.
Wade, D.T., Skilbeck, C.E., Hewer, R.L., 1983. Predicting Barthel ADL
score at 6 months after an acute stroke. Arch. Phys. Med. Rehabil. 64,
24–28.
Zedka, M., Kumar, S., Narayan, Y., 1998. Electromyographic response of
the trunk muscles to postural perturbation in sitting subjects. J.
Electromyogr. Kinesiol. 8, 3–10.