Effects of Compelled Body Weight Shift Therapy on Weight-Bearing Symmetry, Balance and Gait in Patients with Stroke: A Narrative Review

Background: Post-stroke patients exhibit reduced loading over the paretic lower extremity, leading to increased postural sway, balance, and gait asymmetry predisposing to falls. Achieving stance and weight-bearing symmetry are essential contributors in achieving independent ambulation. Compelled body weight shift (CBWS) uses shoe inserts under the non-paretic lower extremity forcing the individual to shift the bodyweight towards the paretic extremity. It facilitates the individuals to overcome the phenomenon of learned disuse and improves weight-bearing symmetry. Purpose: To consolidate evidence regarding the use of CBWS training in achieving weightbearing symmetry, improving balance, and gait in stroke patients. Methods: A comprehensive search was conducted on five databases (PubMed, ClinicalKey, Proquest, ScienceDirect, and Cochrane databases) using predefined MeSH terms. Randomized and non-randomized controlled and clinical trials in the English language published between 2011 and 2021 were retrieved. Result and Discussion: Studies compared the application of shoe inserts of various heights during conventional stroke rehabilitation and their effect on weight-bearing symmetry, balance, and gait. Studies revealed increased weight-bearing on the paretic lower extremity and increased balance performance. Improvement was noted in spatiotemporal parameters of gait; mainly step length, single support stance time, and gait velocity. Conclusion: CBWS using shoe lifts and wedges of different heights under the non-paretic lower extremity during conventional stroke rehabilitation effectively improved weight-bearing symmetry. Shoe lifts were effective in improving balance and weight-bearing symmetry, whereas the use of shoe wedges led to improvements in spatiotemporal gait parameters because of the additional subtalar eversion provided by the wedge.