Neuromuscular Adaptations Following Balance-Oriented Rehabilitation in Stroke Patients with Knee Osteoarthritis.

Background: Stroke and knee osteoarthritis (OA) are prevalent conditions that significantly impair lower limb function and mobility. While stroke rehabilitation focuses on neuroplastic recovery, the presence of OA may limit neuromuscular gains due to pain, joint stiffness, and disuse. Understanding the neuromuscular adaptations from balance-focused rehabilitation in this dual-diagnosis population is essential. Objective: To evaluate neuromuscular adaptations, particularly in hip stabilizers, and improvements in postural control and gait following an 8-week balance-oriented rehabilitation program in stroke patients with knee OA. Methods: A quasi-experimental study was conducted with 18 post-stroke individuals (mean age 64.3 ± 6.1 years) diagnosed with mild-to-moderate knee OA. Participants completed an 8-week intervention consisting of proprioceptive, static and dynamic balance exercises, and hip/core strengthening. Outcomes included hip muscle strength (Manual Muscle Testing), Functional Reach Test (FRT), Timed Up and Go (TUG), Center of Pressure (COP) metrics (Pedalo®-Sensamove), gait parameters (velocity, stride length, cadence), and EMG activation of the gluteus medius and vastus medialis. Data were analyzed using paired t-tests and Pearson correlation. Results: Significant improvements were observed post-intervention in hip flexor strength (p=0.004), FRT (p=0.008), and anterior COP range (p=0.013). EMG amplitude (RMS) of gluteus medius increased by 24.6% during stance tasks (p=0.002). Improvements in EMG activity were moderately correlated with better TUG and FRT scores. Conclusion: Balance-oriented rehabilitation induces favorable neuromuscular adaptations in stroke patients with OA. Strengthening hip stabilizers and enhancing postural control can mitigate the combined impairments of stroke and OA.