Assessment of postural control after spinal cord injury or disease: A narrative review

Following spinal cord injury or disease, impairments in postural control are common regardless of the neurological level or severity of injury. In order to tailor rehabilitation to address an individual's specific impairments and compensations related to postural control, a comprehensive assessment is required. Yet, clinicians and researchers currently lack a standardized approach to the assessment of postural control. The aim of this narrative review is to outline an individualized and comprehensive approach to the assessment of postural control after spinal cord injury or disease. The secondary aims are to describe common impairments in postural control following damage to the spinal cord, and to describe the current state of postural control assessment for individuals living with spinal cord injury or disease. To outline a comprehensive approach, ten components of postural control are described. The components are based on the Systems Framework of Postural Control combined with balance confidence. An individualized approach is achieved by using the stages of the Standing and Walking Assessment Tool to guide the selection of clinical and/or instrumented measures. The Standing and Walking Assessment Tool is a standardized method of describing mobility status after spinal cord injury. For each mobility stage, a combination of measures are recommended that together maximize the comprehensiveness of the assessment. The proposed approach to the assessment of postural control after spinal cord injury or disease may lead to more focused interventions that address an individual's specific impairments, increasing the efficiency of rehabilitation.