Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study

Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? 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A prospective longitudinal cohort study Elissa Embrechts, Jonas Schröder, Tanja C.W. Nijboer, Charlotte van der Waal, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2670039/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jan, 2024 Read the published version in BMC Neurology → Version 1 posted 9 You are reading this latest preprint version Abstract Background Although visuospatial neglect (VSN) has been suggested to limit recovery of standing balance post-stroke, recovery studies investigating this association by means of repeated within-subjects measurements early post-stroke are lacking. Therefore, this cohort study evaluated prospectively if VSN severity is longitudinally associated with (I) an inability to standing independently and (II) impaired postural control and an asymmetric weight-bearing in the first 12 weeks post-stroke. Methods Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated serially at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to evaluate standing independence. Posturographic measure of center-of-pressure velocities (COP vel−ML , COP vel−AP ) and ground reactions forces during quiet standing were used as metrics reflecting postural control and weight-bearing asymmetry (WBA), respectively. Linear mixed models were used to examine associations between egocentric and allocentric VSN, and BBS-s, COP velML , COP vel−AP and WBA within the first 12 weeks post-stroke. Results Egocentric (β= -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN (β= -0.09, 95%CI[-0.15; -0.04], P = .002) were significant, independent factors for BBS-s scores in the first 12 weeks post-stroke. On the other hand, egocentric and allocentric VSN were no longer significant for COP vel−ML , COP vel−AP and WBA in the first 12 weeks post-stroke, after correction for covariates age, muscle strength in the most-affected leg, and contralesional sensory loss. Conclusions Allocentric and egocentric VSN seem to contribute to a decreased standing independence, but not to impaired postural control or greater WBA in the early subacute post-stroke phase. The latter may result from VSN measures being not sensitive enough to detect fine-grained, residual attentional deficits once the individuals regained standing ability. Clinical Trial Registration. Clinicaltrials.gov. unique identifier NCT05060458. Stroke Visuospatial neglect Longitudinal study Posturography Standing balance Postural Control Figures Figure 1 Figure 2 Introduction Regaining independent standing after stroke is an essential precursor for reacquiring walking ability ( 1 , 2 ). Post-stroke standing balance is characterized by underlying impairments in postural control such as increased postural sway of the center-of-pressure (COP) as compared to healthy controls, together with greater weight-bearing on the less-affected leg ( 3 – 7 ). Apart from more severe impairments in lower limb muscle strength ( 3 ), somatosensation ( 8 ) and age ( 3 ), also cognitive deficits have been associated with deficient standing balance after stroke ( 9 , 10 ). Of these cognitive deficits, visuospatial neglect (VSN) stands out as a particularly striking condition, characterized by deficits in lateralized visuospatial cognition, awareness and attention not attributable to sensorimotor or memory impairments ( 11 ). VSN is common after stroke. In the acute phase, prevalence of VSN has been shown to vary between 23% and 48% ( 12 , 13 ). The literature suggests an association between VSN severity and impaired sitting balance, as reflected by more dependency during sitting and larger weight-bearing asymmetry (WBA) ( 9 ). However, so far, the relation between VSN severity and standing balance has been mainly investigated by cross-sectional studies, yielding ambiguous results ( 9 ). In addition, only two longitudinal studies have investigated this association throughout the first weeks post-stroke ( 14 , 15 ), despite this being the period in which gradual improvements in both VSN and balance are seen ( 10 , 16 ). As recovery of both VSN and balance is time-dependent, variability in timing of assessment between previous studies hinders comparison ( 10 , 16 ). It remains, consequently, unknown how VSN recovery contributes to changes in standing balance early post stroke. The overarching aim of this study was therefore to evaluate the longitudinal association of VSN with standing balance within the first 12 weeks post-stroke, by using a repeated measurement design with fixed assessment points relative to stroke onset. For this purpose, we applied posturographic measures of quiet standing by recording ground reaction forces (GRFs) and COP sway, offering greater insight into postural control deficits and WBA as compared to activity scales for balance assessment, such as the Berg Balance Scale ( 17 ) which merely evaluate whether one is able to complete a balance task independently. To investigate the mechanisms underlying a possible association between VSN and standing balance, this study proposes the following research questions: How is VSN severity associated with an improved independence in terms of standing balance within the first 12 weeks post-stroke? How is VSN severity associated with underlying postural control and WBA within the first 12 weeks post-stroke? Regarding our first question, we hypothesized that VSN would be longitudinally associated with decreased standing balance, such that individuals with more severe VSN also exhibit decreased independence in standing. Regarding our second question, we expected that VSN severity would also be associated with greater deficits in underlying postural control, as reflected increased COP sway, and larger weight-bearing on the less-affected leg. Additionally, we hypothesized regarding question 1 and 2 that the proposed longitudinal associations would be independent, such that VSN would remain a significant contributor to standing balance independence, postural control and WBA after controlling for several covariates, including lower limb strength ( 3 ), presence of sensory impairment ( 8 ) and age ( 3 ). Methods Study design This longitudinal prospective cohort study is part of a larger research project, entitled TARGET (Temporal Analyses of hemiplegic Gait and standing balance Early post sTroke; for protocol see) ( 18 ). The protocol is registered online (ClinicalTrials.gov identified: NCT05060458, 29/09/2021), and the study was conducted in conformity with the STROBE statement. Subjects Between October 2019 and December 2021, individuals admitted to one of the cooperating hospitals and rehabilitation facilities (Algemeen Ziekenhuis Geel, GZA Sint-Augustinus, GZA Sint-Vincentius, Universitair Ziekenhuis Antwerpen, RevArte) in the larger Antwerp region, Belgium, for acute or rehabilitation care after an ischemic or hemorrhagic stroke were screened for participation. Potential candidates were included when adhering to the following criteria: 1) CT/MRI-confirmed first-ever unilateral hemispheric stroke with onset less than 3 weeks ago, 2) Reduced muscle strength in the most affected lower limb, defined as a Motricity Index lower extremity score (MI-LE) of < 91 (i.e., at least “movement against resistance but weaker” in one item), 3) Pre-morbid independence in basic activities of daily life (i.e., mRS </=1), 4) Aged between 18 and 90 years old, 5) No severe orthopedic condition of the lower limbs and trunk or other neurological illness, 6) No severe cognitive or communication deficit that interferes with understanding of instructions, 7) (Corrected to) normal visual acuity, and 7) provision of written Informed Consent. Screening and recruitment were performed by EE and JS, together with (para)medical staff employed at the stroke units and rehabilitation facilities. Measurement procedures Serial measurements were scheduled for each subject at week 3, 5, 8 and 12 post-stroke. At inclusion, subjects’ sex, age, stroke side (left/right) and type (ischemic/hemorrhagic) were recorded. At each time-point, VSN measurements, clinical measurements and, once independent standing was achieved, posturographic evaluations were performed. Also the clinical covariates (lower limb strength and sensory loss) were evaluated at each timepoint. Two trained assessors (EE, JS) administered clinical measures (including clinical covariates), and all serial measurements of an individual subject were conducted by the initial assessor. VSN measurements were performed by EE and posturographic measurements by JS. VSN measurements We evaluated both egocentric and allocentric VSN. Egocentric VSN is defined as the impaired ability to report on visual stimuli on the neglected, usually contralesional, side of space. Allocentric VSN is defined as the difficulty to perceive object features on the neglected side regardless of the object’s spatial position ( 13 ). We used the Broken Hearts Test or its variation (Apple’s test) for VSN assessment, which is part of the Oxford Cognitive Screen ( 19 ). Three parallel versions were used and varied randomly across time-points to avoid learning effects. This test is recommended for VSN screening and screens for both subtypes ( 19 – 21 ). It is a paper-and-pencil task in which the individual must cancel complete hearts/apples (n = 50) among distractors shaped as broken hearts/apples with either gaps on the right (n = 50) or left (n = 50) of the contour. It is presented on an A4 landscape paper, whose position is standardized within and across subjects. The paper was attached on a table, centrally and in front of the seated subject. The task was always performed with the less-affected hand, ( 19 , 21 ) and subjects had a maximum of 3 minutes to complete the task. Clinical measurement of standing balance The activity scale for balance evaluation included the “standing unsupported” item of the Berg Balance Scale (BBS-s; score 0–4) ( 17 ). The BBS-s evaluates standing independence, by asking the individual to stand without use of an aid or physical support for 2 minutes, without falling or requiring stepping responses due to instability. Higher scores indicate better performance ( 17 ). Posturographic measurements Postural control and WBA were assessed by instructing subjects to stand as still as possible for 40 seconds while keeping the arms alongside the trunk and eyes fixed at a non-moving visual target placed centrally in front of the subject. The bare feet were always positioned with 8.4 cm heel-to-heel distance and 9 degrees toe-out angle. No further instruction was given regarding weight-bearing symmetry. The first 10 seconds were removed from each trial to avoid starting effects and, if tolerated, at least three trials were performed with resting breaks in-between. To record ground reaction forces and COP excursions, we either used two floor-mounted force plates (Type OR6-7 Biomechanics Force Platform, AMTI, MA, US) at the M²OCEAN movement analyses laboratory (University of Antwerp, BE), or a portable plantar pressure plate (0.5m Footscan pressure plate 3D, RS Scan, Materialize, BE). The latter allowed data collection in clinical environments when access to our laboratory was restricted. Prior to the current study, we performed a comparability study of the two measurement instruments in healthy controls during vision-deprived stance. This yielded strong consistency by Pearson correlation, yet systematic differences, in line with earlier studies ( 22 , 23 ). Therefore, repeated measurements within a specific subject were always performed using the same instrument type and statistical analyses of pooled data between subjects were corrected by entering INSTRUMENT as a covariate (see statistical analyses). COP excursions were computed using custom-written Matlab scripts (force plate data) or the system’s own software (pressure plate data). COP signals were subsequently low-pass filtered with a 10Hz second-order Butterworth filter ( 24 ). Outcome variables Dependent variables The dependent variable to evaluate research question 1 was the BBS-s (score 0–4), a measure of standing independence. For research question 2, dependent variables were measures of postural control and WBA. To quantify postural control, we calculated the root mean square COP velocity in mediolateral and anteroposterior sway directions (COP vel−ML , COP vel−AP ; in mm/s) ( 25 ). This measure was shown to be reliable and valid, by being sensitive to higher-frequent changes in the COP signal reflecting the process of posture stabilization ( 26 ). In addition, WBA (%) was calculated by dividing the average vertical GRF below the more-affected leg by half of the total GRF under both feet combined. A percentage score of 0 indicates perfect symmetry and a positive or negative score reflect, respectively, a greater load on the less- or most-affected leg. All outcomes were averaged to improve reliability ( 24 ). Independent variables VSN outcome variables. The difference between cancelled full outlines on the ipsilesional vs. contralesional side of the paper was used as a measure of egocentric VSN severity and hereafter referred to as egocentric asymmetry (Ego_asym). Egocentric VSN was considered present when Ego_asym > 2 or <-2. Allocentric VSN severity was calculated by subtracting the number of contralesional-gap and ipsilesional-gap false positives and referred to as allocentric asymmetry (Allo_asym). Allocentric VSN was considered present when Allo_asym > 1 or <-1. Positive values indicate contralesional VSN and negative values ipsilesional VSN ( 13 , 19 ). Clinical covariates. Lower limb strength was evaluated with the Motricity Index of the Lower-Extremity (MI-LE) ( 27 ). The MI-LE (0-100) was measured by asking subjects to produce a maximum voluntary torque in direction of hip flexion, knee extension and ankle dorsiflexion. It is a valid and reliable scale ( 27 ). Sensory impairment at the contralesional foot was assessed by applying light pressure touch at 6 points of the contralesional foot, using the Erasmus MC revised Nottingham Sensory Assessment protocol ( 28 ). Sensory impairment was considered present when at least 2 points at the contralesional foot were missed. Statistical analyses Statistical analyses were performed in subjects whose data from at least two measurement points were available. We descriptively presented mean values with standard deviation of demographic information and each investigated outcome measure (i.e., Ego_asym, Allo_asym, BBS-s, MI-LE, sensory loss, COP vel−ML , COP vel−AP , WBA) at week 3, 5, 8 and 12 post-stroke. To investigate longitudinal associations between VSN severity and either clinical (BBS-s) or posturographic measures (i.e., COP vel−ML , COP vel−AP , WBA), we fitted linear mixed models with the same model architecture for each dependent variable. The covariate TIME (categorical, four levels: week 3, 5, 8, 12) was added as a fixed effect. A subject-specific random intercept to account for dependency between repeated within-subject measurements was included. Ego_asym or Allo_asym were entered as independent variables in separate models. Before adding Ego_asym or Allo_asym as independent variables, we calculated Spearman correlation coefficients between both factors, to account for multicollinearity. This showed that both VSN subtypes are independent subtypes (r = .09, P = .297), justifying separate models. For posturographic measures, we accounted for systematic differences in COP between measurement instruments by adding an additional covariate INSTRUMENT. The obtained regression coefficients (β) show the change in, respectively, BBS-s, COP vel−ML , COP vel−AP or WBA by a one-unit increase in either Ego_asym or Allo_asym, respectively. Afterwards, we evaluated whether the contribution of Ego_asym or Allo_asym to the BBS-s, COP vel−ML , COP vel−AP and WBA would remain significant, if other covariates including MI-LE, SENSORY IMPAIRMENT (yes/no) and AGE were added, by using a hierarchical linear mixed model. The proportional change in the β-estimates of Ego_asym and Allo_asym to the outcome after adding subsequent covariates was evaluated. To evaluate whether this would result in a better model fit, we evaluated change in model statistics using the sample size adjusted Akaike Information Criterion (AICc), with lower values indicating better fit. To control for potential ascertainment bias, which refers to the possibility of some subjects being more likely to be included in posturographic analysis than others, we plotted time courses of Ego_asym and Allo_asym for subjects who were and were not able to perform posturographic measurements (i.e., obtained a score of 4 on the BBS-s). To minimize the potential for bias in analysis, we re-ran the model for the BBS-s in subjects with available posturographic measures. For those without available posturographic measures, statistical power was too low to yield meaningful results, and these were consequently left out of further analyses. All analyses were performed in JMP Pro® version 16. Histograms and Q-Q plots of residuals were inspected to confirm model assumptions. Results Subjects Figure 1 shows the flow of subject recruitment. Approximately 180 first-ever stroke survivors were identified as potential candidates, of which 45 adhered to inclusion criteria and were successfully included. Of these, 36 successfully participated in at least two subsequent measurements and were included for analyses. Table 1 shows their baseline characteristics and Table 2 shows the mean values in each outcome variable at week 3, 5, 8 and 12 post-stroke, respectively. Mean age of the 36 included subjects was 59.78 (SD 15.96) years, 17 were female, 22 had a left-sided stroke and 28 suffered an ischemic stroke. As shown, 14 individuals showed egocentric VSN at week 3, 7 at week 5, 9 at week 7 and 3 at week 12. Four individuals showed allocentric VSN at week 3, 6 at week 5, 3 at week 8, 4 at week 12. Table 1 Subject characteristics at 3 weeks post-stroke Total Age (years) 59.78 (15.96) Sex (female/male) 17/19 Body weight, kg 75.39 (14.06) Lesion side (left/right) 14/22 Stroke type (isch/hem) 28/8 Time post-stroke (days) 24.56 (1.93) Hem: hemorrhagic, isch: ischemic. Values are mean (standard deviation). Table 2 Characteristics of subjects at 3, 5, 8 and 12 weeks Week 3 Week 5 Week 8 Week 12 Time post-stroke (days) 24.56 (1.93) 38.74 (2.12) 59.06 (2.31) 88.0 (4.42) Ego_asym (0–20)° 2.97 (3.92) 2.03 (4.04) 1.85 (2.51) 1.08 (1.06) Number of subjects with/without egocentric VSN 14/12 7/29 9/24 3/23 Allo_asym (0–20)° 1.83 (5.02) 0.56 (1.13) 0.42 (1.03) 0.73 (1.12) Number of subjects with/without allocentric VSN 4/32 6/30 3/30 4/22 BBS-s score (0–4) 2.44 (1.75) 2.89 (1.51) 3.39 (1.06) 3.73 (0.53) MI-LE (0-100) 57.42 (22.39) 65.00 (21.14) 71.09 (21.91) 72.31 (19.52) Sensory loss (yes/no/NM) 9/18/9 8/19/9 6/20/7 4/16/6 N 26 28 29 10 Measurement instrument (FP/PP) 6/20 6/22 5/24 4/18 COP vel−ML (mm/s) 7.62 (7.51) 6.31 (6.00) 5.72 (5.58) 5.01 (4.48) COP vel−AP (mm/s) 8.92 (7.45) 8.48 (8.00) 7.59 (6.76) 7.24 (6.36) WBA (%) 43.65 (7.31) 44.40 (8.05) 43.04 (7.89) 43.75 (6.59) Allo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale – standing item, COP vel−AP : COP velocities in anteroposterior direction, COP vel−ML : COP velocities in mediolateral direction, Ego_asym: egocentric asymmetry, FP: force plate, MI-LE: lower extremity part of the motricity index, N: number, NM: not mentioned, PP: pressure plate, SD: standard deviation, VSN: visuospatial neglect, WBA: weight-bearing asymmetry. °Absolute values i.e., values irrespective of contra or ipsilesional side, otherwise these would cancel each other out. Values are mean (standard deviation). Longitudinal association of VSN with clinical measures of standing balance independence As shown inn Table 3 , Ego_asym (β=-0.11; [-0.17;0.06], P < .001) and Allo_asym (β=-0.10; 95%CI[-0.16; 0.03]; P = .002) were significant factors for the BBS-s within the first 12 weeks post-stroke. Longitudinal association of VSN with posturographic outcomes of standing balance Table 3 shows that Ego_asym was a significant factor for COP vel−AP (β=-0.41, 95%CI[-0.75; 0.07], P = .018), but not for COP vel−ML (β=-0.29, [-0.65; 0.08], P = .119) and WBA (β=-0.14, [-0.66; 0.38], P = .585). Allo_asym was not a significant factor for COP vel−ML (β = 0.24, [-0.34;0.83], P = .413), COP vel−AP (β = 0.30, 95%CI [-0.26; 0.86], P = .290) and WBA (β=-0.29, [-1.11; 0.54], P = .487) Hierarchical model to evaluate influence of covariates on longitudinal associations and prediction errors Table 4 shows that Ego_asym (β= -0.08, 95%CI[-0.15;-0.01], P = .029) and Allo_asym (β=-0.09, 95% CI[-0.15; -0.04], P = .002) maintained significance after adding MI-LE, SENSORY IMPAIRMENT and AGE for the BBS-s scores throughout the first 12 weeks post-stroke. Addition of these covariates resulted in a proportional change of -27.27% in the β-estimate of Ego_asym and − 10.00% in the β-estimate of Allo_asym, and decreased the estimated prediction error with 28.13% and 30.83%, respectively for the prediction for BBS-s. In contrast, Ego_asym did not remain a significant factor of the COP vel−AP after adding MI-LE. Secondary analysis Figure 2 shows that three subjects in the Ego_asym and four subjects in the Allo_asym graph were unable to perform posturographic measures throughout the first 12 weeks post-stroke. As shown in the figure, these subjects demonstrated higher Ego_asym and/or Allo_asym scores. Analysis shows that for those who performed posturographic measurements, Ego_asym (β = 0.00, 95%CI[-0.089;0.08], P = .916) and Allo_asym (β= -0.06, 95%CI[-0.19;0.07], P = .375) were no significant predictors of the BBS-s. Table 3 Linear mixed models for activity measures and postural control parameters Model with Ego_asym Ego_asym (β -value (SE, 95%CI, p-value)) Time (β-value (SE, 95%CI, p-value)) Instrument AICc 3w 5w 8w (β-value (SE, 95%CI, p-value)) BBS-s -0.11 (0.03, [-0.17;-0.06] , P < .001)* -1.11 (0.23, [-1.57;-0.67] , P < .001)* -0.78 (0.21, [-1.21;-0.35] , P < .001)* -0.24 (0.22, [-0.67;0.20], P = .280) 385.85 COP vel−ML -0.29 (0.18, [-0.65;0.08], P = .119) 3.37 (0.78, [1.81;4.92] , P < .001)* 1.42 (0.75, [-0.06;2.91], P = .061) 0.84 (0.73, [-0.62;2.30], P = .255) 9.29 (2.06, [5.07;13.51] , P < .001)* 576.16 COP vel−AP -0.41 (0.17, [-0.75;-0.07] , P = .018)* 2.37 (0.72, [0.93;3.81] , P = .002)* 1.17 (0.69, [-0.21;2.55], P = .095) 0.44 (0.68, [-0.92;1.79], P = .523) 12.32 (2.33, [7.57;17.08] , P < .001)* 572.34 WBA -0.14 (0.26, [-0.66;0.38], P = .585) -0.68 (1.12, [-2.91;1.55], P = .545) 1.02 (1.07, [-1.11;3.15], P = .344) 0.06 (1.05, [-2.03;2.15], P = .953) -3.79 (3.22, [-10.37;2.80], P = .249) 656.96 Model with Allo_asym Allo_asym β -value (SE, 95%CI, p-value) Time (β-value (SE, 95%CI, p-value)) Instrument AICc 3w 5w 8w (β-value (SE, 95%CI, p-value)) BBS-s -0.11 (0.03, [-0.17;-0.06] , P < .001)* -1.11 (0.23, [-1.57;-0.67] , P < .001)* -0.78 (0.21, [-1.21;-0.35] , P < .001)* -0.24 (0.22, [-0.67;0.20], P = .280) 385.85 COP vel−ML 0.24 (0.30, [-0.34;0.83], P = .413) 3.08 (0.77, [1.55;4.61] , P < .001)* 1.33 (0.76, [-0.19;2.85], P = .085) 0.54 (0.72, [-0.89;1.97], P = .456)* 9.64 (2.04, [5.48;13.80] , P < .001)* 578.00 COP vel−AP 0.30 (0.28, [-0.26;0.86], P = .290) 1.95 (0.73, [0.50;3.40] , P = .009)* 1.01 (0.72, [-0.42;2.45], P = .163) -0.00 (0.68, [-1.35;1.35], P = .998) 12.80 (2.28, [8.13;17.46] , P < .001)* 577.04 WBA -0.29 (0.41, [-1.11;0.54], P = .487) -0.94 (1.07, [-3.08;1.20], P = .382) 0.78 (1.06, [-1.34;2.90], P = .464) -0.12 (1.00, [-2.12;1.87], P = .902) 3.83 (3.25, [-10.47;2.81], P = .248) 656.76 AICc: sample size adjusted Akaike Information Criterion, Allo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale – standing unsupported item, CI: confidence interval, COP vel−AP : anteroposterior center-of-pressure velocities, COP vel−ML : mediolateral center-of-pressure velocities, Ego_asym: egocentric asymmetry, SE: standard error, w: weeks; WBA: weight-bearing asymmetry, β: estimate, * P < .05. Table 4 Hierarchical model with addition of Motricity Index, sensory impairment and age Model with Ego_asym β Ego_asym (SE, 95%CI, p-value) β Ego_asym change β MI-LE (SE, 95%CI, p-value) β Sensory loss (SE, 95%CI, p-value) β Age (SE, 95%CI, p-value) AICc (change%) BBS-s Standard -0.11 (0.03, [-0.17;-0.06] , P < .001)* 385.85 Model 1 -0.11 (0.02, [-0.16;-0.07] , P < .001)* 0% 0.04 (0.01, [0.03;0.05] , P < .001)* 352.38 (-8.67%) Model 2 -0.08 (0.04, [-0.15;-0.01] , P = .027)* -27.27% 0.03 (0.01, [0.02;0.05] , P < .001)* 0.57 (0.32, [-0.07;1.20] , P = .079)* 275.00 (-28.73%) Model 3 -0.08 (0.04, [-0.15;-0.01] , P = .029)* -27.27% 0.03 (0.01, [0.02;0.04] , P < .001)* 0.58 (0.32, [-0.07;1.22] , P = .078)* -0.01 (0.00, [-0.03; 0.02], P = .617) 277.30 (-28.13%) COP vel−AP Standard -0.41 (0.17, [-0.75;0.07] , P = .018)* 572.34 Model 1 -0.29 (0.17, [-0.63;0.06], P = .106) -29.27% -0.12 (0.03,[-0.18;-0.05] , P < .001)* 563.02 (-1.63%) Model 2 0.04 (0.15, [-0.26;0.34, P = .815) -109.76% -0.07 (0.03; [-0.12;-0.01] , P = .021]* -3.34 (1.00, [-5.33;-1.34] , P = .001)* 409.72 (-28.41%) Model 3 0.04 (0.15, [-0.26;0.34, P = .793) -109.76% -0.07 (0.03; [-0.13;-0.01] , P = .017)* -3.37 (1.01, [-5.37;-1.37] , P = .001)* -0.05 (0.06, [-0.16;0.07], P = .396) 411.57 (-28.09%) Model with β Allo_asym β Allo_asym (SE, 95%CI, p-value) β Allo_asym change β MI-LE (SE, 95%CI, p-value) β Sensory loss (SE, 95%CI, p-value) β Age (SE, 95%CI, p-value) AICc (change%) BBS-s Standard -0.10 (0.03; [-0.16;-0.03]; P = .002)* 392.58 Model 1 -0.07 (0.03, [-0.13;-0.02] , P = .008)* -30.00% 0.04 (0.01, [0.02;0.05] , P < .001)* 365.03 (-7.02%) Model 2 -0.09 (0.03, [-0.15;-0.04] , P = .001)* -10.00% 0.03 (0.01, [0.01;0.04] , P < .001)* 0.79 (0.31, [0.17;1.41] , P = .013)* 269.10 (-31.45%) Model 3 -0.09 (0.03, [-0.15;-0.04] , P = .002)* -10.00% 0.03 (0.01, [0.01;0.04] , P < .001)* 0.79 (0.31, [0.17;1.41] , P = .013)* -0.00 (0.01, [-0.02;0.02], P = .724) 271.54 (-30.83%) AICc: sample size adjusted Akaike Information Criterion, Allo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale – standing item, COPvel-AP: anteroposterior center-of-pressure velocities, Ego_asym: egocentric asymmetry, Model 1: model with VSN and motricity index scores, Model 2: model with VSN, motricity index and sensory loss, Model 3: model with VSN, motricity index, sensory loss and age, SE: standard error, β: estimate. Discussion The present prospective cohort study evaluated the longitudinal association of egocentric and allocentric VSN with standing balance within the first 12 weeks post-stroke. So far, mainly cross-sectional studies investigated correlations between VSN severity on the one hand, and deficient standing balance on the other hand. However, longitudinal studies that evaluate how VSN contributes to changes in standing balance early after stroke are lacking. To this end, we performed serial assessments at fixed time-points relative to stroke onset in 36 individuals after stroke. Standing balance was assessed using clinical measures (BBS-s) and posturographic measures that evaluate underlying impairments in postural control (COP vel−ML , COP vel−AP ) and WBA. We investigated whether the contribution of VSN to each outcome would remain significant after controlling for several covariates that were a priori defined based on the available literature, including strength of the most-affected leg ( 3 ), presence of sensory impairment ( 8 ) and age ( 3 ). Our main findings were that Egocentric and allocentric asymmetry were significant, independent factors longitudinal associated with decreased standing independence in the first 12 weeks post-stroke. When correcting for potential ascertainment bias by selecting only subjects that completed posturographic measures of quiet standing balance, egocentric and allocentric asymmetry were no longer significantly associated with standing independence. Egocentric and allocentric asymmetry severity did not significantly contribute to impaired postural control or WBA in the first 12 weeks post-stroke. First, after controlling for various covariates, the severity of VSN remained a significant and independent predictor of decreased standing independence. This result confirms our hypothesis regarding research question 1 and is congruent with findings from the literature ( 14 ). For example, a prior prospective cohort study conducted by Van Nes and colleagues ( 14 ) also found that egocentric VSN severity was accompanied with reduced standing and walking independence in the first 3–6 months post-stroke. However, our study extends the previous one by controlling for important covariates including the strength of the most-affected leg, sensory loss, and age in a multivariate way. Moreover, previous studies have only focused on the association between egocentric VSN and standing balance after stroke ( 9 ). To the best of our knowledge, this is the first study to examine the relative contribution of both egocentric and allocentric VSN on standing balance recovery post-stroke, and our findings suggest that both aspects contribute to poor standing balance independence. Despite a significant association of VSN severity with decreased standing independence, a lack of an independent longitudinal association with underlying impaired postural control and WBA was found. This is opposing our a priori hypothesis regarding research question 2, and may suggest that once a subject resumed independent standing, VSN did not independently contribute to deficits in postural control, as reflected by exaggerated COP sway. This may further indicate that delayed achievement of independent standing in individuals exhibiting VSN would result from factors other than impaired postural control. Furthermore, VSN did not independently contribute to WBA within the first 12 weeks post-stroke, suggesting that an asymmetric stance with greater loading of the less-affected leg is not an expression of reduced attention to the most-affected side and a consequent shift in the representation of the mid-sagittal plane toward the less-affected side, although this has been suggested previously ( 29 ). Alternatively, the absence of a longitudinal association of VSN with postural control deficits and WBA may result from the observation that subjects with more severe (initial) VSN were unable to participate in posturographic measures, as shown in Fig. 2. To further evaluate this hypothesis, our analysis regarding standing independence as the dependent variables was performed again by only selecting subjects who successfully underwent posturographic measures, thereby excluding those with more severe VSN. This selection resulted in a non-significant longitudinal association of VSN with the BBS-s within the first 12 weeks post-stroke. This highlights that investigating postural control mechanisms and WBA over time in those with initial moderate-to-severe VSN poses a significant challenge, as subjects must have the ability to stand independently to conduct such analyses. Potentially, once subjects with initial moderate-to-severe VSN (here measured using the Broken Hearts Test) reach standing ability, VSN may no longer be detectable on such tests. As shown in Fig. 2, VSN scores reached a ceiling effect between 5 and 8 weeks, and residual fine impairments in VSN beyond this time window could not be demonstrated ( 30 – 32 ). Future research should be mindful to include more sensitive measures of VSN, for example by including tasks that further increase attentional demands. A previous study by Bonato and colleagues ( 33 ) found residual improvement of VSN in the chronic post-stroke phase, using a task that increased attentional demands such that the depletable attentional resources necessary to deploy compensatory strategies were more intensively loaded, which is suggested to complicate the deployment of compensatory strategies ( 34 ). Limitations Several limitations of this study should be acknowledged. One limitation is the small sample size together with the dropout rate from 8 weeks onwards (27.8%), which was due to medical reasons and difficulties in scheduling measurements in the clinical setting after early discharge. In addition, COVID-19 measures prohibited the subjects’ outpatient access to the clinical sites. This may have resulted in under-powered analysis to show significance. Furthermore, only few subjects showed large deviations in VSN which may have further limited our results. A second limitation is that the assessments of subjects were not initiated until 3 weeks post-stroke which may have resulted in missing early changes in the association of VSN with standing balance. Furthermore, posturographic measurements started even beyond this time-point in the more severely-affected subjects, which may have limited our findings. Third, posturographic data were collected using two different instruments. We believe that this did not affect our findings, considering we used the same instrument within subjects and added an extra covariate INSTRUMENT within the final analyses. Fourth, a limitation of the linear mixed model approach used in the present study is that it combines within-subject and between-subject associations, which may limit the ability to fully understand the mechanisms driving the observed longitudinal associations between VSN severity and standing balance independence. Lastly, the BBS-s is a widely used tool, but it is a categorical measure rather than a continuous one, which may limit its sensitivity. Conclusion Severity of egocentric and allocentric VSN was longitudinally associated with decreased standing independence in the first 12 weeks post-stroke. However, no significant longitudinal associations with postural control and WBA during quiet standing were observed. This suggests that the mechanisms underlying poor standing balance in individuals with VSN should involve other factors. However, this finding may have been influenced by the observation that the subjects with initially more severe VSN were unable to perform posturographic measurements. Consequently, evaluating postural control and WBA in those with initial moderate-to-severe VSN poses a significant challenge. Given that VSN may not be detectable anymore on classical paper-and-pen tests once these individuals regain standing ability, future research on standing balance recovery should implement more sensitive VSN measures that can detect residual impairments beyond this time window. Declarations Ethics approval and consent to participate All procedures were conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of the University Hospital Antwerp (No. 18/25/305; Belgium trial registration no. B300201837010). Additional approval was obtained from the medical ethics committee of other involved sites. After receiving information, all subjects gave written informed consent for participation. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests None. Funding The present study was partially funded by the Special Research Fund of the University of Antwerp (DOCPRO no. 40180, research fellow EE) and Research Foundation Flanders (FWO application no. 1S64819N, fellow JS). Author’s contributions Conceptualization, data collection, formal analysis, writing, original and final draft preparation: Elissa Embrechts Conceptualization, data collection, formal analysis, review: Jonas Schröder, Charlotte van der Waal Conceptualization, data collection, formal analysis, review, supervision: Tanja C.W. Nijboer Conceptualization, review, supervision: Wim Saeys Supervision: Steven Truijen, Christophe Lafosse All authors have read and agreed to the version of the manuscript. Acknowledgement The authors thank the cooperating hospitals/rehabilitation facilities (Algemeen Ziekenhuis Geel, GZA Sint-Augustinus, GZA Sint-Vincentius, Universitair Ziekenhuis Antwerpen and RevArte). They also express their gratitude to Erik Fransen (StatUA, University of Antwerp) for statistical assistance. References Smith MC, Barber AP, Scrivener BJ, Stinear CM. The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study. Neurorehabil Neural Repair. 2022;36(7):461–71. Kollen B, van de Port I, Lindeman E, Twisk J, Kwakkel G. Predicting improvement in gait after stroke: a longitudinal prospective study. Stroke. 2005;36(12):2676–80. Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait Posture. 2005;22(3):267–81. Sackley CM. Falls, sway, and symmetry of weight-bearing after stroke. Int Disabil Stud. 1991;13(1):1–4. Rode G, Tiliket C, Boisson D. Predominance of postural imbalance in left hemiparetic patients. Scand J Rehabil Med. 1997;29(1):11–6. Laufer Y, Sivan D, Schwarzmann R, Sprecher E. 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The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27–36. Schröder J, Saeys W, Yperzeele L, Kwakkel G, Truijen S. Time Course and Mechanisms Underlying Standing Balance Recovery Early After Stroke: Design of a Prospective Cohort Study With Repeated Measurements. Front Neurol. 2022;13:781416. Demeyere N, Riddoch MJ, Slavkova ED, Bickerton WL, Humphreys GW. The Oxford Cognitive Screen (OCS): validation of a stroke-specific short cognitive screening tool. Psychol Assess. 2015;27(3):883–94. Moore M, Milosevich E, Beisteiner R, Bowen A, Checketts M, Demeyere N, et al. Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations. Eur J Neurol. 2022;29(9):2596–606. Demeyere N, Riddoch MJ, Slavkova ED, Jones K, Reckless I, Mathieson P, et al. Domain-specific versus generalized cognitive screening in acute stroke. J Neurol. 2016;263(2):306–15. Goetschius J, Feger MA, Hertel J, Hart JM. Validating Center-of-Pressure Balance Measurements Using the MatScan(R) Pressure Mat.J Sport Rehabil. 2018;27(1). Bickley C, Linton J, Sullivan E, Mitchell K, Slota G, Barnes D. Comparison of simultaneous static standing balance data on a pressure mat and force plate in typical children and in children with cerebral palsy. Gait Posture. 2019;67:91–8. Lafond D, Corriveau H, Hébert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Arch Phys Med Rehabil. 2004;85(6):896–901. Roelofs JMB, van Heugten K, de Kam D, Weerdesteyn V, Geurts ACH. Relationships Between Affected-Leg Motor Impairment, Postural Asymmetry, and Impaired Body Sway Control After Unilateral Supratentorial Stroke. Neurorehabil Neural Repair. 2018;32(11):953–60. Geurts AC, Nienhuis B, Mulder TW. Intrasubject variability of selected force-platform parameters in the quantification of postural control. Arch Phys Med Rehabil. 1993;74(11):1144–50. Collen FM, Wade DT, Bradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disabil Stud. 1990;12(1):6–9. Stolk-Hornsveld F, Crow JL, Hendriks EP, van der Baan R, Harmeling-van der Wel BC. The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders. Clin Rehabil. 2006;20(2):160–72. Genthon N, Rougier P, Gissot AS, Froger J, Pélissier J, Pérennou D. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008;39(6):1793–9. Spreij LA, Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Simulated driving: The added value of dynamic testing in the assessment of visuo-spatial neglect after stroke. J Neuropsychol. 2020;14(1):28–45. Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Dynamic assessment of visual neglect: The Mobility Assessment Course as a diagnostic tool. J Clin Exp Neuropsychol. 2018;40(2):161–72. Pedroli E, Serino S, Cipresso P, Pallavicini F, Riva G. Assessment and rehabilitation of neglect using virtual reality: a systematic review.Frontiers in Behavioral Neuroscience. 2015;9. Bonato M. Unveiling residual, spontaneous recovery from subtle hemispatial neglect three years after stroke. Front Hum Neurosci. 2015;9:413. Bonato M. Neglect and extinction depend greatly on task demands: a review. Front Hum Neurosci. 2012;6:195. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Jan, 2024 Read the published version in BMC Neurology → Version 1 posted Editorial decision: Major revision 05 Oct, 2023 Reviewers agreed at journal 10 Jul, 2023 Reviews received at journal 10 Jul, 2023 Reviewers agreed at journal 21 Jun, 2023 Reviewers invited by journal 27 Apr, 2023 Editor assigned by journal 19 Apr, 2023 Editor invited by journal 22 Mar, 2023 Submission checks completed at journal 22 Mar, 2023 First submitted to journal 08 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2670039","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":185576211,"identity":"58b13833-33a8-4d5c-9e2a-0e7a2694cd44","order_by":0,"name":"Elissa Embrechts","email":"data:image/png;base64,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","orcid":"","institution":"University of Antwerp","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Elissa","middleName":"","lastName":"Embrechts","suffix":""},{"id":185576212,"identity":"93cd6576-f956-4ac9-9c0b-f24cb575edac","order_by":1,"name":"Jonas Schröder","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jonas","middleName":"","lastName":"Schröder","suffix":""},{"id":185576213,"identity":"cc8f573c-a4ea-4897-9ae4-1e67218eafc4","order_by":2,"name":"Tanja C.W. Nijboer","email":"","orcid":"","institution":"Utrecht University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tanja","middleName":"C.W.","lastName":"Nijboer","suffix":""},{"id":185576214,"identity":"f5bf7b96-5e35-4859-80b5-10804af7e213","order_by":3,"name":"Charlotte van der Waal","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Charlotte","middleName":"van der","lastName":"Waal","suffix":""},{"id":185576215,"identity":"156c2726-4b24-4fff-bfef-ceab130a4e03","order_by":4,"name":"Christophe Lafosse","email":"","orcid":"","institution":"RevArte Rehabilitation Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Christophe","middleName":"","lastName":"Lafosse","suffix":""},{"id":185576216,"identity":"e3f89e01-c359-40ce-97df-bdfd3abe074f","order_by":5,"name":"Steven Truijen","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Steven","middleName":"","lastName":"Truijen","suffix":""},{"id":185576217,"identity":"d8386c6f-f66b-4990-ab6a-af95fe859813","order_by":6,"name":"Wim Saeys","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wim","middleName":"","lastName":"Saeys","suffix":""}],"badges":[],"createdAt":"2023-03-08 14:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2670039/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2670039/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-023-03475-1","type":"published","date":"2024-01-22T15:18:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":34794303,"identity":"6a31abff-ed7b-4aed-a682-7dcb568271f4","added_by":"auto","created_at":"2023-03-24 18:16:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":244869,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of screening, inclusion and follow-up\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2670039/v1/dc024081c1b08773f8895eeb.jpg"},{"id":34794302,"identity":"fd3a5645-1752-442a-8268-8f77d67df8fb","added_by":"auto","created_at":"2023-03-24 18:16:01","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":170049,"visible":true,"origin":"","legend":"\u003cp\u003ea-b. Time course of egocentric asymmetry and allocentric asymmetry in subjects that were or were not able to perform posturographic measures.\u003c/p\u003e\n\u003cp\u003eAbbreviations: Allo_asym: allocentric asymmetry, Ego_asym: egocentric asymmetry.\u003c/p\u003e\n\u003cp\u003eLight grey lines show the time courses of Ego_asym and Allo_asym in those who were able to perform posturographic measures. Dark grey lines show the time courses for those who were unable to perform posturographic measures.\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2670039/v1/c26bd21db35ca675a785adab.jpeg"},{"id":50314316,"identity":"77005bae-0171-4eff-bbeb-b735e08bcc17","added_by":"auto","created_at":"2024-01-29 15:30:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":857336,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2670039/v1/79dd0a45-4ebc-4c4d-876b-304dd5256038.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRegaining independent standing after stroke is an essential precursor for reacquiring walking ability (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Post-stroke standing balance is characterized by underlying impairments in postural control such as increased postural sway of the center-of-pressure (COP) as compared to healthy controls, together with greater weight-bearing on the less-affected leg (\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Apart from more severe impairments in lower limb muscle strength (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), somatosensation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and age (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), also cognitive deficits have been associated with deficient standing balance after stroke (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Of these cognitive deficits, visuospatial neglect (VSN) stands out as a particularly striking condition, characterized by deficits in lateralized visuospatial cognition, awareness and attention not attributable to sensorimotor or memory impairments (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). VSN is common after stroke. In the acute phase, prevalence of VSN has been shown to vary between 23% and 48% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe literature suggests an association between VSN severity and impaired sitting balance, as reflected by more dependency during sitting and larger weight-bearing asymmetry (WBA) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, so far, the relation between VSN severity and standing balance has been mainly investigated by cross-sectional studies, yielding ambiguous results (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In addition, only two longitudinal studies have investigated this association throughout the first weeks post-stroke (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), despite this being the period in which gradual improvements in both VSN and balance are seen (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). As recovery of both VSN and balance is time-dependent, variability in timing of assessment between previous studies hinders comparison (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It remains, consequently, unknown how VSN recovery contributes to changes in standing balance early post stroke.\u003c/p\u003e \u003cp\u003eThe overarching aim of this study was therefore to evaluate the longitudinal association of VSN with standing balance within the first 12 weeks post-stroke, by using a repeated measurement design with fixed assessment points relative to stroke onset. For this purpose, we applied posturographic measures of quiet standing by recording ground reaction forces (GRFs) and COP sway, offering greater insight into postural control deficits and WBA as compared to activity scales for balance assessment, such as the Berg Balance Scale (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) which merely evaluate whether one is able to complete a balance task independently. To investigate the mechanisms underlying a possible association between VSN and standing balance, this study proposes the following research questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow is VSN severity associated with an improved independence in terms of standing balance within the first 12 weeks post-stroke?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow is VSN severity associated with underlying postural control and WBA within the first 12 weeks post-stroke?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eRegarding our first question, we hypothesized that VSN would be longitudinally associated with decreased standing balance, such that individuals with more severe VSN also exhibit decreased independence in standing. Regarding our second question, we expected that VSN severity would also be associated with greater deficits in underlying postural control, as reflected increased COP sway, and larger weight-bearing on the less-affected leg. Additionally, we hypothesized regarding question 1 and 2 that the proposed longitudinal associations would be independent, such that VSN would remain a significant contributor to standing balance independence, postural control and WBA after controlling for several covariates, including lower limb strength (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), presence of sensory impairment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and age (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis longitudinal prospective cohort study is part of a larger research project, entitled TARGET (Temporal Analyses of hemiplegic Gait and standing balance Early post sTroke; for protocol see) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The protocol is registered online (ClinicalTrials.gov identified: NCT05060458, 29/09/2021), and the study was conducted in conformity with the STROBE statement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003e Between October 2019 and December 2021, individuals admitted to one of the cooperating hospitals and rehabilitation facilities (Algemeen Ziekenhuis Geel, GZA Sint-Augustinus, GZA Sint-Vincentius, Universitair Ziekenhuis Antwerpen, RevArte) in the larger Antwerp region, Belgium, for acute or rehabilitation care after an ischemic or hemorrhagic stroke were screened for participation. Potential candidates were included when adhering to the following criteria: 1) CT/MRI-confirmed first-ever unilateral hemispheric stroke with onset less than 3 weeks ago, 2) Reduced muscle strength in the most affected lower limb, defined as a Motricity Index lower extremity score (MI-LE) of \u0026lt;\u0026thinsp;91 (i.e., at least \u0026ldquo;movement against resistance but weaker\u0026rdquo; in one item), 3) Pre-morbid independence in basic activities of daily life (i.e., mRS \u0026lt;/=1), 4) Aged between 18 and 90 years old, 5) No severe orthopedic condition of the lower limbs and trunk or other neurological illness, 6) No severe cognitive or communication deficit that interferes with understanding of instructions, 7) (Corrected to) normal visual acuity, and 7) provision of written Informed Consent. Screening and recruitment were performed by EE and JS, together with (para)medical staff employed at the stroke units and rehabilitation facilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement procedures\u003c/h2\u003e \u003cp\u003eSerial measurements were scheduled for each subject at week 3, 5, 8 and 12 post-stroke. At inclusion, subjects\u0026rsquo; sex, age, stroke side (left/right) and type (ischemic/hemorrhagic) were recorded. At each time-point, VSN measurements, clinical measurements and, once independent standing was achieved, posturographic evaluations were performed. Also the clinical covariates (lower limb strength and sensory loss) were evaluated at each timepoint. Two trained assessors (EE, JS) administered clinical measures (including clinical covariates), and all serial measurements of an individual subject were conducted by the initial assessor. VSN measurements were performed by EE and posturographic measurements by JS.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eVSN measurements\u003c/h2\u003e \u003cp\u003eWe evaluated both egocentric and allocentric VSN. Egocentric VSN is defined as the impaired ability to report on visual stimuli on the neglected, usually contralesional, side of space. Allocentric VSN is defined as the difficulty to perceive object features on the neglected side regardless of the object\u0026rsquo;s spatial position (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). We used the Broken Hearts Test or its variation (Apple\u0026rsquo;s test) for VSN assessment, which is part of the Oxford Cognitive Screen (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Three parallel versions were used and varied randomly across time-points to avoid learning effects. This test is recommended for VSN screening and screens for both subtypes (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It is a paper-and-pencil task in which the individual must cancel complete hearts/apples (n\u0026thinsp;=\u0026thinsp;50) among distractors shaped as broken hearts/apples with either gaps on the right (n\u0026thinsp;=\u0026thinsp;50) or left (n\u0026thinsp;=\u0026thinsp;50) of the contour. It is presented on an A4 landscape paper, whose position is standardized within and across subjects. The paper was attached on a table, centrally and in front of the seated subject. The task was always performed with the less-affected hand, (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and subjects had a maximum of 3 minutes to complete the task.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eClinical measurement of standing balance\u003c/h2\u003e \u003cp\u003eThe activity scale for balance evaluation included the \u0026ldquo;standing unsupported\u0026rdquo; item of the Berg Balance Scale (BBS-s; score 0\u0026ndash;4) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The BBS-s evaluates standing independence, by asking the individual to stand without use of an aid or physical support for 2 minutes, without falling or requiring stepping responses due to instability. Higher scores indicate better performance (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003ePosturographic measurements\u003c/h2\u003e \u003cp\u003ePostural control and WBA were assessed by instructing subjects to stand as still as possible for 40 seconds while keeping the arms alongside the trunk and eyes fixed at a non-moving visual target placed centrally in front of the subject. The bare feet were always positioned with 8.4 cm heel-to-heel distance and 9 degrees toe-out angle. No further instruction was given regarding weight-bearing symmetry. The first 10 seconds were removed from each trial to avoid starting effects and, if tolerated, at least three trials were performed with resting breaks in-between. To record ground reaction forces and COP excursions, we either used two floor-mounted force plates (Type OR6-7 Biomechanics Force Platform, AMTI, MA, US) at the \u003cem\u003eM\u0026sup2;OCEAN\u003c/em\u003e movement analyses laboratory (University of Antwerp, BE), or a portable plantar pressure plate (0.5m Footscan pressure plate 3D, RS Scan, Materialize, BE). The latter allowed data collection in clinical environments when access to our laboratory was restricted. Prior to the current study, we performed a comparability study of the two measurement instruments in healthy controls during vision-deprived stance. This yielded strong consistency by Pearson correlation, yet systematic differences, in line with earlier studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Therefore, repeated measurements \u003cem\u003ewithin\u003c/em\u003e a specific subject were always performed using the same instrument type and statistical analyses of pooled data \u003cem\u003ebetween\u003c/em\u003e subjects were corrected by entering INSTRUMENT as a covariate (see statistical analyses). COP excursions were computed using custom-written Matlab scripts (force plate data) or the system\u0026rsquo;s own software (pressure plate data). COP signals were subsequently low-pass filtered with a 10Hz second-order Butterworth filter (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eOutcome variables\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eDependent variables\u003c/h2\u003e \u003cp\u003eThe dependent variable to evaluate research question 1 was the BBS-s (score 0\u0026ndash;4), a measure of standing independence. For research question 2, dependent variables were measures of postural control and WBA. To quantify postural control, we calculated the root mean square COP velocity in mediolateral and anteroposterior sway directions (COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e; in mm/s) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This measure was shown to be reliable and valid, by being sensitive to higher-frequent changes in the COP signal reflecting the process of posture stabilization (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition, WBA (%) was calculated by dividing the average vertical GRF below the more-affected leg by half of the total GRF under both feet combined. A percentage score of 0 indicates perfect symmetry and a positive or negative score reflect, respectively, a greater load on the less- or most-affected leg. All outcomes were averaged to improve reliability (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eVSN outcome variables.\u003c/span\u003e The difference between cancelled full outlines on the ipsilesional vs. contralesional side of the paper was used as a measure of egocentric VSN severity and hereafter referred to as egocentric asymmetry (Ego_asym). Egocentric VSN was considered present when Ego_asym\u0026thinsp;\u0026gt;\u0026thinsp;2 or \u0026lt;-2. Allocentric VSN severity was calculated by subtracting the number of contralesional-gap and ipsilesional-gap false positives and referred to as allocentric asymmetry (Allo_asym). Allocentric VSN was considered present when Allo_asym\u0026thinsp;\u0026gt;\u0026thinsp;1 or \u0026lt;-1. Positive values indicate contralesional VSN and negative values ipsilesional VSN (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eClinical covariates.\u003c/span\u003e Lower limb strength was evaluated with the Motricity Index of the Lower-Extremity (MI-LE) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The MI-LE (0-100) was measured by asking subjects to produce a maximum voluntary torque in direction of hip flexion, knee extension and ankle dorsiflexion. It is a valid and reliable scale (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Sensory impairment at the contralesional foot was assessed by applying light pressure touch at 6 points of the contralesional foot, using the Erasmus MC revised Nottingham Sensory Assessment protocol (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Sensory impairment was considered present when at least 2 points at the contralesional foot were missed.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed in subjects whose data from at least two measurement points were available. We descriptively presented mean values with standard deviation of demographic information and each investigated outcome measure (i.e., Ego_asym, Allo_asym, BBS-s, MI-LE, sensory loss, COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e, WBA) at week 3, 5, 8 and 12 post-stroke.\u003c/p\u003e \u003cp\u003eTo investigate longitudinal associations between VSN severity and either clinical (BBS-s) or posturographic measures (i.e., COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e, WBA), we fitted linear mixed models with the same model architecture for each dependent variable. The covariate TIME (categorical, four levels: week 3, 5, 8, 12) was added as a fixed effect. A subject-specific random intercept to account for dependency between repeated within-subject measurements was included. Ego_asym or Allo_asym were entered as independent variables in separate models. Before adding Ego_asym or Allo_asym as independent variables, we calculated Spearman correlation coefficients between both factors, to account for multicollinearity. This showed that both VSN subtypes are independent subtypes (r\u0026thinsp;=\u0026thinsp;.09, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.297), justifying separate models. For posturographic measures, we accounted for systematic differences in COP between measurement instruments by adding an additional covariate INSTRUMENT. The obtained regression coefficients (β) show the change in, respectively, BBS-s, COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e or WBA by a one-unit increase in either Ego_asym or Allo_asym, respectively.\u003c/p\u003e \u003cp\u003eAfterwards, we evaluated whether the contribution of Ego_asym or Allo_asym to the BBS-s, COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e and WBA would remain significant, if other covariates including MI-LE, SENSORY IMPAIRMENT (yes/no) and AGE were added, by using a hierarchical linear mixed model. The proportional change in the β-estimates of Ego_asym and Allo_asym to the outcome after adding subsequent covariates was evaluated. To evaluate whether this would result in a better model fit, we evaluated change in model statistics using the sample size adjusted Akaike Information Criterion (AICc), with lower values indicating better fit.\u003c/p\u003e \u003cp\u003eTo control for potential ascertainment bias, which refers to the possibility of some subjects being more likely to be included in posturographic analysis than others, we plotted time courses of Ego_asym and Allo_asym for subjects who were and were not able to perform posturographic measurements (i.e., obtained a score of 4 on the BBS-s). To minimize the potential for bias in analysis, we re-ran the model for the BBS-s in subjects with available posturographic measures. For those without available posturographic measures, statistical power was too low to yield meaningful results, and these were consequently left out of further analyses.\u003c/p\u003e \u003cp\u003eAll analyses were performed in JMP Pro\u0026reg; version 16. Histograms and Q-Q plots of residuals were inspected to confirm model assumptions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the flow of subject recruitment. Approximately 180 first-ever stroke survivors were identified as potential candidates, of which 45 adhered to inclusion criteria and were successfully included. Of these, 36 successfully participated in at least two subsequent measurements and were included for analyses. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows their baseline characteristics and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the mean values in each outcome variable at week 3, 5, 8 and 12 post-stroke, respectively. Mean age of the 36 included subjects was 59.78 (SD 15.96) years, 17 were female, 22 had a left-sided stroke and 28 suffered an ischemic stroke. As shown, 14 individuals showed egocentric VSN at week 3, 7 at week 5, 9 at week 7 and 3 at week 12. Four individuals showed allocentric VSN at week 3, 6 at week 5, 3 at week 8, 4 at week 12.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubject characteristics at 3 weeks post-stroke\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.78 (15.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (female/male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17/19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.39 (14.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion side (left/right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke type (isch/hem)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28/8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime post-stroke (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.56 (1.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHem: hemorrhagic, isch: ischemic. Values are mean (standard deviation).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of subjects at 3, 5, 8 and 12 weeks\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeek 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWeek 5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeek 8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeek 12\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime post-stroke (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.56 (1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.74 (2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.06 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.0 (4.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgo_asym (0\u0026ndash;20)\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.97 (3.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.03 (4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.85 (2.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08 (1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of subjects with/without egocentric VSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9/24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllo_asym (0\u0026ndash;20)\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83 (5.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56 (1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.73 (1.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of subjects with/without allocentric VSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBBS-s score (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.44 (1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.89 (1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.39 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.73 (0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMI-LE (0-100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.42 (22.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.00 (21.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.09 (21.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.31 (19.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSensory loss (yes/no/NM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/18/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8/19/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/20/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/16/6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasurement instrument (FP/PP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5/24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e (mm/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.62 (7.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.31 (6.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.72 (5.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.01 (4.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e (mm/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.92 (7.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.48 (8.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.59 (6.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.24 (6.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBA (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.65 (7.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.40 (8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.04 (7.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.75 (6.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAllo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale \u0026ndash; standing item, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e: COP velocities in anteroposterior direction, COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e: COP velocities in mediolateral direction, Ego_asym: egocentric asymmetry, FP: force plate, MI-LE: lower extremity part of the motricity index, N: number, NM: not mentioned, PP: pressure plate, SD: standard deviation, VSN: visuospatial neglect, WBA: weight-bearing asymmetry. \u0026deg;Absolute values i.e., values irrespective of contra or ipsilesional side, otherwise these would cancel each other out. Values are mean (standard deviation).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLongitudinal association of VSN with clinical measures of standing balance independence\u003c/p\u003e \u003cp\u003eAs shown inn Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Ego_asym (β=-0.11; [-0.17;0.06], P\u0026thinsp;\u0026lt;\u0026thinsp;.001) and Allo_asym (β=-0.10; 95%CI[-0.16; 0.03]; P\u0026thinsp;=\u0026thinsp;.002) were significant factors for the BBS-s within the first 12 weeks post-stroke.\u003c/p\u003e \u003cp\u003eLongitudinal association of VSN with posturographic outcomes of standing balance\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that Ego_asym was a significant factor for COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e (β=-0.41, 95%CI[-0.75; 0.07], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.018), but not for COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e (β=-0.29, [-0.65; 0.08], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.119) and WBA (β=-0.14, [-0.66; 0.38], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.585). Allo_asym was not a significant factor for COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e (β\u0026thinsp;=\u0026thinsp;0.24, [-0.34;0.83], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.413), COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e (β\u0026thinsp;=\u0026thinsp;0.30, 95%CI [-0.26; 0.86], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.290) and WBA (β=-0.29, [-1.11; 0.54], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.487)\u003c/p\u003e \u003cp\u003eHierarchical model to evaluate influence of covariates on longitudinal associations and prediction errors\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that Ego_asym (β= -0.08, 95%CI[-0.15;-0.01], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.029) and Allo_asym (β=-0.09, 95% CI[-0.15; -0.04], \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.002) maintained significance after adding MI-LE, SENSORY IMPAIRMENT and AGE for the BBS-s scores throughout the first 12 weeks post-stroke. Addition of these covariates resulted in a proportional change of -27.27% in the β-estimate of Ego_asym and \u0026minus;\u0026thinsp;10.00% in the β-estimate of Allo_asym, and decreased the estimated prediction error with 28.13% and 30.83%, respectively for the prediction for BBS-s. In contrast, Ego_asym did not remain a significant factor of the COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e after adding MI-LE.\u003c/p\u003e \u003cp\u003eSecondary analysis\u003c/p\u003e \u003cp\u003eFigure 2 shows that three subjects in the Ego_asym and four subjects in the Allo_asym graph were unable to perform posturographic measures throughout the first 12 weeks post-stroke. As shown in the figure, these subjects demonstrated higher Ego_asym and/or Allo_asym scores. Analysis shows that for those who performed posturographic measurements, Ego_asym (β\u0026thinsp;=\u0026thinsp;0.00, 95%CI[-0.089;0.08], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.916) and Allo_asym (β= -0.06, 95%CI[-0.19;0.07], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.375) were no significant predictors of the BBS-s.\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear mixed models for activity measures and postural control parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eModel with Ego_asym\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEgo_asym\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(β -value (SE, 95%CI, p-value))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTime\u003c/b\u003e (β-value (SE, 95%CI, p-value))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eInstrument\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAICc\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(β-value (SE, 95%CI, p-value))\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBBS-s\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.17;-0.06]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.23, [-1.57;-0.67]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.21, [-1.21;-0.35]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003cp\u003e(0.22, [-0.67;0.20], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.280)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e385.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOP\u003c/b\u003e\u003csub\u003e\u003cb\u003evel\u0026minus;ML\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003cp\u003e(0.18, [-0.65;0.08], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.37\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.78, [1.81;4.92]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003cp\u003e(0.75, [-0.06;2.91], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.061)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003cp\u003e(0.73, [-0.62;2.30], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.255)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e9.29\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2.06, [5.07;13.51]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e576.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOP\u003c/b\u003e\u003csub\u003e\u003cb\u003evel\u0026minus;AP\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.41\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.17, [-0.75;-0.07]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;.018)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.37\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.72, [0.93;3.81]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;.002)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003cp\u003e(0.69, [-0.21;2.55], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.095)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003cp\u003e(0.68, [-0.92;1.79], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.523)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e12.32\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2.33, [7.57;17.08]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e572.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003cp\u003e(0.26, [-0.66;0.38], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.68\u003c/p\u003e \u003cp\u003e(1.12, [-2.91;1.55], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.545)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003cp\u003e(1.07, [-1.11;3.15], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.344)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003cp\u003e(1.05, [-2.03;2.15], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.953)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.79\u003c/p\u003e \u003cp\u003e(3.22, [-10.37;2.80], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.249)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e656.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel with Allo_asym\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAllo_asym\u003c/b\u003e\u003c/p\u003e \u003cp\u003eβ -value (SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTime\u003c/b\u003e (β-value (SE, 95%CI, p-value))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eInstrument\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eAICc\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(β-value (SE, 95%CI, p-value))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBBS-s\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.17;-0.06]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.23, [-1.57;-0.67]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.21, [-1.21;-0.35]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003cp\u003e(0.22, [-0.67;0.20], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.280)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e385.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOP\u003c/b\u003e\u003csub\u003e\u003cb\u003evel\u0026minus;ML\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003cp\u003e(0.30, [-0.34;0.83], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.413)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.08\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.77, [1.55;4.61]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003cp\u003e(0.76, [-0.19;2.85], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.085)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003cp\u003e(0.72, [-0.89;1.97], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.456)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e9.64\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2.04, [5.48;13.80]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e578.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOP\u003c/b\u003e\u003csub\u003e\u003cb\u003evel\u0026minus;AP\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003cp\u003e(0.28, [-0.26;0.86], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.95\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.73, [0.50;3.40]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;.009)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003cp\u003e(0.72, [-0.42;2.45], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.00\u003c/p\u003e \u003cp\u003e(0.68, [-1.35;1.35], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.998)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e12.80\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2.28, [8.13;17.46]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e577.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003cp\u003e(0.41, [-1.11;0.54], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.487)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.94\u003c/p\u003e \u003cp\u003e(1.07, [-3.08;1.20], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.382)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003cp\u003e(1.06, [-1.34;2.90], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.464)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003cp\u003e(1.00, [-2.12;1.87], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.902)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.83\u003c/p\u003e \u003cp\u003e(3.25, [-10.47;2.81], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.248)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e656.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAICc: sample size adjusted Akaike Information Criterion, Allo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale \u0026ndash; standing unsupported item, CI: confidence interval, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e: anteroposterior center-of-pressure velocities, COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e: mediolateral center-of-pressure velocities, Ego_asym: egocentric asymmetry, SE: standard error, w: weeks; WBA: weight-bearing asymmetry, β: estimate, *\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHierarchical model with addition of Motricity Index, sensory impairment and age\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eModel with Ego_asym\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ Ego_asym\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ Ego_asym change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ MI-LE\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ Sensory loss\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eβ Age\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAICc (change%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBBS-s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.17;-0.06]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e385.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.02, [-0.16;-0.07]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.03;0.05]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e352.38\u003c/p\u003e \u003cp\u003e(-8.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.08\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.04, [-0.15;-0.01]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.027)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-27.27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.02;0.05]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.57\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.32, [-0.07;1.20]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.079)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e275.00\u003c/p\u003e \u003cp\u003e(-28.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.08\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.04, [-0.15;-0.01]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.029)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-27.27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.02;0.04]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.58\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.32, [-0.07;1.22]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.078)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003cp\u003e(0.00, [-0.03; 0.02], \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.617)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e277.30\u003c/p\u003e \u003cp\u003e(-28.13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCOP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.41\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.17, [-0.75;0.07]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.018)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e572.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003cp\u003e(0.17, [-0.63;0.06], \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.106)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-29.27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.12\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03,[-0.18;-0.05]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e563.02 \u003c/p\u003e \u003cp\u003e(-1.63%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003cp\u003e(0.15, [-0.26;0.34, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.815)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-109.76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.07\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03; [-0.12;-0.01]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.021]*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-3.34\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(1.00, [-5.33;-1.34]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e409.72\u003c/p\u003e \u003cp\u003e(-28.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003cp\u003e(0.15, [-0.26;0.34, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.793)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-109.76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.07\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03; [-0.13;-0.01]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.017)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-3.37\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(1.01, [-5.37;-1.37]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003cp\u003e(0.06, [-0.16;0.07], \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.396)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e411.57\u003c/p\u003e \u003cp\u003e(-28.09%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModel with β Allo_asym\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ Allo_asym\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ Allo_asym change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ MI-LE\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ Sensory loss\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eβ Age\u003c/p\u003e \u003cp\u003e(SE, 95%CI, p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAICc (change%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBBS-s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.10\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03; [-0.16;-0.03];\u003c/b\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.002)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e392.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.07\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.13;-0.02]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.008)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-30.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.02;0.05]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e365.03\u003c/p\u003e \u003cp\u003e(-7.02%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.09\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.15;-0.04]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.01;0.04]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.31, [0.17;1.41]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.013)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e269.10\u003c/p\u003e \u003cp\u003e(-31.45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.09\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.03, [-0.15;-0.04]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.002)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.01, [0.01;0.04]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.31, [0.17;1.41]\u003c/b\u003e, \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP\u0026thinsp;=\u003c/span\u003e\u0026thinsp;\u003cb\u003e.013)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.00\u003c/p\u003e \u003cp\u003e(0.01, [-0.02;0.02], \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.724)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e271.54\u003c/p\u003e \u003cp\u003e(-30.83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eAICc: sample size adjusted Akaike Information Criterion, Allo_asym: allocentric asymmetry, BBS-s: Berg Balance Scale \u0026ndash; standing item, COPvel-AP: anteroposterior center-of-pressure velocities, Ego_asym: egocentric asymmetry, Model 1: model with VSN and motricity index scores, Model 2: model with VSN, motricity index and sensory loss, Model 3: model with VSN, motricity index, sensory loss and age, SE: standard error, β: estimate.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present prospective cohort study evaluated the longitudinal association of egocentric and allocentric VSN with standing balance within the first 12 weeks post-stroke. So far, mainly cross-sectional studies investigated correlations between VSN severity on the one hand, and deficient standing balance on the other hand. However, longitudinal studies that evaluate how VSN contributes to changes in standing balance early after stroke are lacking. To this end, we performed serial assessments at fixed time-points relative to stroke onset in 36 individuals after stroke. Standing balance was assessed using clinical measures (BBS-s) and posturographic measures that evaluate underlying impairments in postural control (COP\u003csub\u003evel\u0026minus;ML\u003c/sub\u003e, COP\u003csub\u003evel\u0026minus;AP\u003c/sub\u003e) and WBA. We investigated whether the contribution of VSN to each outcome would remain significant after controlling for several covariates that were a priori defined based on the available literature, including strength of the most-affected leg (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), presence of sensory impairment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and age (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Our main findings were that\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEgocentric and allocentric asymmetry were significant, independent factors longitudinal associated with decreased standing independence in the first 12 weeks post-stroke.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhen correcting for potential ascertainment bias by selecting only subjects that completed posturographic measures of quiet standing balance, egocentric and allocentric asymmetry were no longer significantly associated with standing independence.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEgocentric and allocentric asymmetry severity did not significantly contribute to impaired postural control or WBA in the first 12 weeks post-stroke.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFirst, after controlling for various covariates, the severity of VSN remained a significant and independent predictor of decreased standing independence. This result confirms our hypothesis regarding research question 1 and is congruent with findings from the literature (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For example, a prior prospective cohort study conducted by Van Nes and colleagues (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) also found that egocentric VSN severity was accompanied with reduced standing and walking independence in the first 3\u0026ndash;6 months post-stroke. However, our study extends the previous one by controlling for important covariates including the strength of the most-affected leg, sensory loss, and age in a multivariate way. Moreover, previous studies have only focused on the association between egocentric VSN and standing balance after stroke (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). To the best of our knowledge, this is the first study to examine the relative contribution of both egocentric and allocentric VSN on standing balance recovery post-stroke, and our findings suggest that both aspects contribute to poor standing balance independence.\u003c/p\u003e \u003cp\u003eDespite a significant association of VSN severity with decreased standing independence, a lack of an independent longitudinal association with underlying impaired postural control and WBA was found. This is opposing our a priori hypothesis regarding research question 2, and may suggest that once a subject resumed independent standing, VSN did not independently contribute to deficits in postural control, as reflected by exaggerated COP sway. This may further indicate that delayed achievement of independent standing in individuals exhibiting VSN would result from factors other than impaired postural control. Furthermore, VSN did not independently contribute to WBA within the first 12 weeks post-stroke, suggesting that an asymmetric stance with greater loading of the less-affected leg is not an expression of reduced attention to the most-affected side and a consequent shift in the representation of the mid-sagittal plane toward the less-affected side, although this has been suggested previously (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlternatively, the absence of a longitudinal association of VSN with postural control deficits and WBA may result from the observation that subjects with more severe (initial) VSN were unable to participate in posturographic measures, as shown in Fig.\u0026nbsp;2. To further evaluate this hypothesis, our analysis regarding standing independence as the dependent variables was performed again by only selecting subjects who successfully underwent posturographic measures, thereby excluding those with more severe VSN. This selection resulted in a non-significant longitudinal association of VSN with the BBS-s within the first 12 weeks post-stroke. This highlights that investigating postural control mechanisms and WBA over time in those with initial moderate-to-severe VSN poses a significant challenge, as subjects must have the ability to stand independently to conduct such analyses. Potentially, once subjects with initial moderate-to-severe VSN (here measured using the Broken Hearts Test) reach standing ability, VSN may no longer be detectable on such tests. As shown in Fig.\u0026nbsp;2, VSN scores reached a ceiling effect between 5 and 8 weeks, and residual fine impairments in VSN beyond this time window could not be demonstrated (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Future research should be mindful to include more sensitive measures of VSN, for example by including tasks that further increase attentional demands. A previous study by Bonato and colleagues (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) found residual improvement of VSN in the chronic post-stroke phase, using a task that increased attentional demands such that the depletable attentional resources necessary to deploy compensatory strategies were more intensively loaded, which is suggested to complicate the deployment of compensatory strategies (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this study should be acknowledged. One limitation is the small sample size together with the dropout rate from 8 weeks onwards (27.8%), which was due to medical reasons and difficulties in scheduling measurements in the clinical setting after early discharge. In addition, COVID-19 measures prohibited the subjects\u0026rsquo; outpatient access to the clinical sites. This may have resulted in under-powered analysis to show significance. Furthermore, only few subjects showed large deviations in VSN which may have further limited our results. A second limitation is that the assessments of subjects were not initiated until 3 weeks post-stroke which may have resulted in missing early changes in the association of VSN with standing balance. Furthermore, posturographic measurements started even beyond this time-point in the more severely-affected subjects, which may have limited our findings. Third, posturographic data were collected using two different instruments. We believe that this did not affect our findings, considering we used the same instrument within subjects and added an extra covariate INSTRUMENT within the final analyses. Fourth, a limitation of the linear mixed model approach used in the present study is that it combines within-subject and between-subject associations, which may limit the ability to fully understand the mechanisms driving the observed longitudinal associations between VSN severity and standing balance independence. Lastly, the BBS-s is a widely used tool, but it is a categorical measure rather than a continuous one, which may limit its sensitivity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSeverity of egocentric and allocentric VSN was longitudinally associated with decreased standing independence in the first 12 weeks post-stroke. However, no significant longitudinal associations with postural control and WBA during quiet standing were observed. This suggests that the mechanisms underlying poor standing balance in individuals with VSN should involve other factors. However, this finding may have been influenced by the observation that the subjects with initially more severe VSN were unable to perform posturographic measurements. Consequently, evaluating postural control and WBA in those with initial moderate-to-severe VSN poses a significant challenge. Given that VSN may not be detectable anymore on classical paper-and-pen tests once these individuals regain standing ability, future research on standing balance recovery should implement more sensitive VSN measures that can detect residual impairments beyond this time window.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eAll procedures were conducted in accordance with the\u0026nbsp;Declaration of Helsinki and approved by the Medical Ethics Committee of the University Hospital Antwerp (No. 18/25/305;\u0026nbsp;Belgium trial registration no. B300201837010). Additional approval was obtained from the medical ethics committee of other involved sites. After receiving information,\u0026nbsp;all subjects gave written informed consent for participation.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe present study was partially funded by the Special Research Fund of the University of Antwerp (DOCPRO no. 40180, research fellow EE) and Research Foundation Flanders (FWO application no. 1S64819N, fellow JS).\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s contributions\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eConceptualization, data collection, formal analysis, writing, original and final draft preparation: Elissa Embrechts\u003c/li\u003e\n \u003cli\u003eConceptualization, data collection, formal analysis, review: Jonas Schr\u0026ouml;der, Charlotte van der Waal\u003c/li\u003e\n \u003cli\u003eConceptualization, data collection, formal analysis, review, supervision: Tanja C.W. Nijboer\u003c/li\u003e\n \u003cli\u003eConceptualization, review, supervision: Wim Saeys\u003c/li\u003e\n \u003cli\u003eSupervision: Steven Truijen, Christophe Lafosse\u003c/li\u003e\n \u003cli\u003eAll authors have read and agreed to the version of the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors thank the cooperating hospitals/rehabilitation facilities (Algemeen Ziekenhuis Geel, GZA Sint-Augustinus, GZA Sint-Vincentius, Universitair Ziekenhuis Antwerpen and \u0026nbsp; RevArte). They also express their gratitude to Erik Fransen (StatUA, University of Antwerp) for statistical assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmith MC, Barber AP, Scrivener BJ, Stinear CM. The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study. Neurorehabil Neural Repair. 2022;36(7):461\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKollen B, van de Port I, Lindeman E, Twisk J, Kwakkel G. Predicting improvement in gait after stroke: a longitudinal prospective study. Stroke. 2005;36(12):2676\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait Posture. 2005;22(3):267\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSackley CM. Falls, sway, and symmetry of weight-bearing after stroke. Int Disabil Stud. 1991;13(1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRode G, Tiliket C, Boisson D. Predominance of postural imbalance in left hemiparetic patients. Scand J Rehabil Med. 1997;29(1):11\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaufer Y, Sivan D, Schwarzmann R, Sprecher E. Standing balance and functional recovery of patients with right and left hemiparesis in the early stages of rehabilitation. Neurorehabil Neural Repair. 2003;17(4):207\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeurala SH, K\u0026ouml;n\u0026ouml;nen P, Pitk\u0026auml;nen K, Sivenius J, Tarkka IM. Postural instability in patients with chronic stroke. Restor Neurol Neurosci. 2007;25(2):101\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParsons SL, Mansfield A, Inness EL, Patterson KK. The relationship of plantar cutaneous sensation and standing balance post-stroke. Top Stroke Rehabil. 2016;23(5):326\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmbrechts E, Van Criekinge T, Schr\u0026ouml;der J, Nijboer T, Lafosse C, Truijen S et al. The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review.Annals of Physical and Rehabilitation Medicine. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuvarp D, Rafsten L, Abzhandadze T, Sunnerhagen KS. A cohort study on longitudinal changes in postural balance during the first year after stroke. BMC Neurol. 2022;22(1):324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeilman KM, Valenstein E. Mechanisms underlying hemispatial neglect. Ann Neurol. 1979;5(2):166\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsposito E, Shekhtman G, Chen P. Prevalence of spatial neglect post-stroke: A systematic review. Ann Phys Rehabil Med. 2021;64(5):101459.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemeyere N, Gillebert CR. Ego- and allocentric visuospatial neglect: Dissociations, prevalence, and laterality in acute stroke. Neuropsychology. 2019;33(4):490\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Nes IJ, van Kessel ME, Schils F, Fasotti L, Geurts AC, Kwakkel G. Is visuospatial hemineglect longitudinally associated with postural imbalance in the postacute phase of stroke? Neurorehabil Neural Repair. 2009;23(8):819\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerry SB, Marchetti GF, Wagner S, Wilton W. Predicting caregiver assistance required for sit-to-stand following rehabilitation for acute stroke. J Neurol Phys Ther. 2006;30(1):2\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNijboer TC, Kollen BJ, Kwakkel G. Time course of visuospatial neglect early after stroke: a longitudinal cohort study. Cortex. 2013;49(8):2021\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchr\u0026ouml;der J, Saeys W, Yperzeele L, Kwakkel G, Truijen S. Time Course and Mechanisms Underlying Standing Balance Recovery Early After Stroke: Design of a Prospective Cohort Study With Repeated Measurements. Front Neurol. 2022;13:781416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemeyere N, Riddoch MJ, Slavkova ED, Bickerton WL, Humphreys GW. The Oxford Cognitive Screen (OCS): validation of a stroke-specific short cognitive screening tool. Psychol Assess. 2015;27(3):883\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore M, Milosevich E, Beisteiner R, Bowen A, Checketts M, Demeyere N, et al. Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations. Eur J Neurol. 2022;29(9):2596\u0026ndash;606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemeyere N, Riddoch MJ, Slavkova ED, Jones K, Reckless I, Mathieson P, et al. Domain-specific versus generalized cognitive screening in acute stroke. J Neurol. 2016;263(2):306\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoetschius J, Feger MA, Hertel J, Hart JM. Validating Center-of-Pressure Balance Measurements Using the MatScan(R) Pressure Mat.J Sport Rehabil. 2018;27(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBickley C, Linton J, Sullivan E, Mitchell K, Slota G, Barnes D. Comparison of simultaneous static standing balance data on a pressure mat and force plate in typical children and in children with cerebral palsy. Gait Posture. 2019;67:91\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLafond D, Corriveau H, H\u0026eacute;bert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Arch Phys Med Rehabil. 2004;85(6):896\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoelofs JMB, van Heugten K, de Kam D, Weerdesteyn V, Geurts ACH. Relationships Between Affected-Leg Motor Impairment, Postural Asymmetry, and Impaired Body Sway Control After Unilateral Supratentorial Stroke. Neurorehabil Neural Repair. 2018;32(11):953\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeurts AC, Nienhuis B, Mulder TW. Intrasubject variability of selected force-platform parameters in the quantification of postural control. Arch Phys Med Rehabil. 1993;74(11):1144\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollen FM, Wade DT, Bradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disabil Stud. 1990;12(1):6\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStolk-Hornsveld F, Crow JL, Hendriks EP, van der Baan R, Harmeling-van der Wel BC. The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders. Clin Rehabil. 2006;20(2):160\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenthon N, Rougier P, Gissot AS, Froger J, P\u0026eacute;lissier J, P\u0026eacute;rennou D. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008;39(6):1793\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpreij LA, Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Simulated driving: The added value of dynamic testing in the assessment of visuo-spatial neglect after stroke. J Neuropsychol. 2020;14(1):28\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTen Brink AF, Visser-Meily JMA, Nijboer TCW. Dynamic assessment of visual neglect: The Mobility Assessment Course as a diagnostic tool. J Clin Exp Neuropsychol. 2018;40(2):161\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePedroli E, Serino S, Cipresso P, Pallavicini F, Riva G. Assessment and rehabilitation of neglect using virtual reality: a systematic review.Frontiers in Behavioral Neuroscience. 2015;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonato M. Unveiling residual, spontaneous recovery from subtle hemispatial neglect three years after stroke. Front Hum Neurosci. 2015;9:413.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonato M. Neglect and extinction depend greatly on task demands: a review. Front Hum Neurosci. 2012;6:195.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stroke, Visuospatial neglect, Longitudinal study, Posturography, Standing balance, Postural Control","lastPublishedDoi":"10.21203/rs.3.rs-2670039/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2670039/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eAlthough visuospatial neglect (VSN) has been suggested to limit recovery of standing balance post-stroke, recovery studies investigating this association by means of repeated within-subjects measurements early post-stroke are lacking. Therefore, this cohort study evaluated prospectively if VSN severity is longitudinally associated with (I) an inability to standing independently and (II) impaired postural control and an asymmetric weight-bearing in the first 12 weeks post-stroke.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eThirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated serially at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to evaluate standing independence. Posturographic measure of center-of-pressure velocities (COP\u003csub\u003evel−ML\u003c/sub\u003e, COP\u003csub\u003evel−AP\u003c/sub\u003e) and ground reactions forces during quiet standing were used as metrics reflecting postural control and weight-bearing asymmetry (WBA), respectively. Linear mixed models were used to examine associations between egocentric and allocentric VSN, and BBS-s, COP\u003csub\u003evelML\u003c/sub\u003e, COP\u003csub\u003evel−AP\u003c/sub\u003e and WBA within the first 12 weeks post-stroke.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eEgocentric (β= -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN (β= -0.09, 95%CI[-0.15; -0.04], P = .002) were significant, independent factors for BBS-s scores in the first 12 weeks post-stroke. On the other hand, egocentric and allocentric VSN were no longer significant for COP\u003csub\u003evel−ML\u003c/sub\u003e, COP\u003csub\u003evel−AP\u003c/sub\u003e and WBA in the first 12 weeks post-stroke, after correction for covariates age, muscle strength in the most-affected leg, and contralesional sensory loss.\u003c/p\u003e\n\u003ch2\u003eConclusions\u003c/h2\u003e\n\u003cp\u003eAllocentric and egocentric VSN seem to contribute to a decreased standing independence, but not to impaired postural control or greater WBA in the early subacute post-stroke phase. The latter may result from VSN measures being not sensitive enough to detect fine-grained, residual attentional deficits once the individuals regained standing ability.\u003c/p\u003e\n\u003ch2\u003eClinical Trial Registration.\u003c/h2\u003e\n\u003cp\u003eClinicaltrials.gov. unique identifier NCT05060458.\u003c/p\u003e","manuscriptTitle":"Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? 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