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Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke.

ABSTRACT: BACKGROUND:Stepping is critical for responding to perturbations, whether externally induced or self-initiated. Falls post-stroke is equally likely to happen from either mechanism. The objective of the study was, to examine lateral stepping performance during waist-pull induced reactive steps and voluntary choice reaction time steps in chronic stroke and controls. METHODS:In this cross-sectional study participants with chronic stroke (N?=?10) and age- and gender-matched controls (N?=?10) performed reactive and voluntary lateral steps. Step initiation time, global step length, step clearance, and step velocity were calculated. Other measures for reactive step included, Balance tolerance limit (perturbation magnitude when recovery transitioned from single to multiple steps), and step type. The Community Balance & Mobility Scale, and hip abductor and adductor isokinetic asymmetry torque ratio were assessed. RESULTS:The paretic and non-paretic leg were combined since step characteristics did not differ. Step (voluntary vs. reactive) by group (stroke vs. controls) was significant for step initiation time. The stroke group took longer initiating a voluntary step (P?=?0.004). Reactive and voluntary steps were executed slower (P?=?0.041), with a reduced step length (P?=?0.028) by the stroke group. The stroke group had a lower balance tolerance limit (P?=?0.01) and took reactive medial steps more frequently (P?=?0.001). The Community Balance & Mobility Scale (P?>?0.001), and hip abductor and adductor asymmetry torque ratio (P?>?0.001; P?=?0.015) was reduced in the stroke group. SIGNIFICANCE:Our findings indicate individuals post-stroke are slower initiating and executing reactive and voluntary steps. Though the reactive step timing is less impaired, this may be a method for enhancing faster voluntary movements and training reactive balance.

SUBMITTER: Gray VL

PROVIDER: S-EPMC6589388 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke.

Gray Vicki L VL Yang Chieh-Ling CL Fujimoto Masahiro M McCombe Waller Sandy S Rogers Mark W MW

Gait & posture 20190503

<h4>Background</h4>Stepping is critical for responding to perturbations, whether externally induced or self-initiated. Falls post-stroke is equally likely to happen from either mechanism. The objective of the study was, to examine lateral stepping performance during waist-pull induced reactive steps and voluntary choice reaction time steps in chronic stroke and controls.<h4>Methods</h4>In this cross-sectional study participants with chronic stroke (N = 10) and age- and gender-matched controls (N ...[more]

PMID: 31078009

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Project description:BACKGROUND AND PURPOSE:Falls commonly occur as weight is transferred laterally, and impaired reactive stepping responses are associated with falls after stroke. The purpose of this study was to examine differences in and the determinants of mediolateral (M-L) protective stepping strategies when pulled off balance toward the paretic and nonparetic sides. METHODS:Eighteen individuals more than 6 months poststroke were pulled in the M-L direction by a lateral waist-pull perturbation system. Step type (crossover, medial, and lateral) and count were recorded, along with first-step initiation time, length, and clearance. Sensorimotor variables including hip adductor/abductor and ankle plantar flexor/dorsiflexor peak isokinetic torques, paretic foot plantar cutaneous sensation, and motor recovery were used to predict step type by discriminant function analyses (DFAs). RESULTS:Regardless of pull direction, nearly 70% of trials required 2 or more recovery steps, with more frequent nonparetic leg first steps, 63.5%. The step type was significantly different for pull direction (P = 0.005), with a greater percentage of lateral steps when pulled toward the nonparetic side (45.1%) compared with the paretic side (17.5%). The M-L step length of the lateral step was increased (P < 0.001), with a reduced step clearance (P = 0.05), when pulled toward the paretic side compared with a pull toward the nonparetic side. DFAs revealed that nonparetic and paretic-side pulls could respectively classify step type 64% and 60% of the time, with foot cutaneous sensation discriminating for pull direction. DISCUSSION AND CONCLUSIONS:Balance recovery initiated with the nonparetic leg occurred more frequently in response to M-L perturbations, and paretic foot cutaneous sensation was an important predictor of the stepping response regardless of the pull direction.Video Abstract available for more insights from the authors (see Video, Supplementary Digital Content 1, http://links.lww.com/JNPT/A190).

Dataset Information

Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke.

Publications

Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke.

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