Background and Purpose-This study compared the psychometric properties of 3 clinical balance measures, the Berg Balance Scale (BBS), the Balance subscale of the Fugl-Meyer test (FM-B), and the Postural Assessment Scale for Stroke Patients (PASS), in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset. Methods-One hundred twenty-three stroke patients were followed up prospectively with the 3 balance measures 14, 30, 90, and 180 days after stroke onset (DAS). Reliability (interrater reliability and internal consistency) and validity (concurrent validity, convergent validity, and predictive validity) of each measure were examined. A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity. Results-The FM-B and BBS showed a significant floor or ceiling effect at some DAS points, whereas the PASS did not show these effects. The BBS, FM-B, and PASS all had good reliability and validity for patients at different recovery stages after stroke. The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but, as expected, only a low level of responsiveness at 90 to 180 DAS. The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset, 14 to 30 DAS. Conclusions-All 3 measures tested showed very acceptable levels of reliability, validity, and responsiveness for both clinicians and researchers. The PASS showed slightly better psychometric characteristics than the other 2 measures.

Stroke is a leading cause of long-term disability. Impairments resulting from stroke lead to persistent difficulties with walking and subsequently, improved walking ability is one of the highest priorities for people living with a stroke. In addition, walking ability has important health implications in providing protective effects against secondary complications common after a stroke such as heart disease or osteoporosis. This paper systematically reviews common gait training strategies (neurodevelopmental techniques, muscle strengthening, treadmill training, intensive mobility exercises) to improve walking ability. The results (descriptive summaries as well as pooled effect sizes) from randomized controlled trials are presented and implications for optimal gait training strategies are discussed. Novel and emerging gait training strategies are highlighted and research directions proposed to enable the optimal recovery and maintenance of walking ability. Keywords gait; walking; systematic review; meta-analysis; stroke; CVA; rehabilitation; treadmill; mobility; exercise I. Walking ability of people with strokeStroke is a leading cause of long-term disability which results from brain cell damage due to either an interruption of the blood supply to the brain or hemorrhage into the brain tissue. As a result of an increasing older adult population, coupled with an ever improving acute phase survival rate, the absolute number of persons with stroke is increasing [1]. Of the individuals who survive, approximately 75 to 85% are ultimately discharged home [2,3]. Ninety percent of stroke survivors have some functional disability with mobility being a major impairment [4]. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptAlthough some individuals with stroke will have received some rehabilitation during the acute and sub-acute phases, rarely does rehabilitation extend beyond one year post-injury due to the belief that a plateau in functional recovery has been reached by this time and also due to a lack of resources for long term services. Impairments resulting from stroke, such as muscle weakness, pain, spasticity and poor balance can lead to a reduced tolerance to activity and further sedentary lifestyle. Community-dwelling individuals with stroke undertake extremely low levels of physical activity [5].Although 65% to 85% of stroke survivors learn to walk independently by 6 months post stroke [6], gait abnormalities persist through the chronic stages of the condition. Walking endurance, as measured by the distance walked in 6 minutes (Six Minute Walk Test or 6MWT), remains the most striking area of difficulty among individuals with chronic stroke [7].Patients with stroke spend more of their rehabilitation time practicing walking compared to all other activities [8]. Improved walking ability is one of the most often stated goals by people with stroke undergoing rehabilitation [9] and with those individuals living with stroke in the community [10].Walking ability has important implications for he...

In this article, we highlight the unique nature of balance control during walking in humans. A control framework, including proactive and reactive balance control, is introduced to lay out age-related changes in different balance control mechanisms during walking. Clinical implications that may be useful for clinicians for assessment and treatment of balance problems that occur during walking are also discussed.

Studies on the proactive control of gait have shown that proximal (hip/trunk) muscles are the primary contributors to balance control, while studies on reactive balance control during perturbed gait, examining only activity in distal (leg/thigh) muscles, have shown that these muscles are important in compensating for a gait disturbance. This study tested the hypothesis that proximal muscles are also primary contributors to reactive balance control during perturbed gait. Thirty-three young adults participated in a study in which an anterior slip was simulated at heel strike by the forward displacement of a force plate on which they walked. Surface electromyographic data were recorded from bilateral leg, thigh, hip and trunk muscles. Kinematic data were collected on joint angle changes in response to the perturbation. The results did not support the hypothesis that the proximal muscles contribute significantly to balance control during perturbed gait. The proximal muscles did not demonstrate more consistent activation, earlier onset latency, longer burst duration or larger burst magnitude than distal muscles. Moreover, although proximal postural activity was often present in the first slip trial, it tended to adapt away in later trials. By contrast, the typical postural responses exhibited by young adults consisted of an early (90-140 ms), high-magnitude (4-9 times muscle activity during normal walking) and relatively long duration (70-200 ms) activation of bilateral anterior leg muscles as well as the anterior and posterior thigh muscles. Thus, postural activity from bilateral leg and thigh muscles and the coordination between the two lower extremities were the key to reactive balance control and were sufficient for regaining balance within one gait cycle. The adaptive attenuation of proximal postural activity over repeated trials suggests that the nervous system overcompensates for a novel balance threat in the first slip trial and fine-tunes its responses with experience.

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Background. Slips account for a high percentage of falls and subsequent injuries in community-dwelling older adults but not in young adults. This phenomenon suggests that although active and healthy older adults preserve a mobility level comparable to that of young adults, these older adults may have difficulty generating efficient reactive postural responses when they slip. This study tested the hypothesis that active and healthy older adults use a less effective reactive balance strategy than young adults when experiencing an unexpected forward slip occurring at heel strike during walking. This less effective balance strategy would be manifested by slower and smaller postural responses, altered temporal and spatial organization of the postural responses, and greater upper trunk instability after the slip.

The accelerometer was found to be a reliable objective instrument. The use of accelerometers quantified the low level of free-living physical activity of people with stroke.