Anterior fall-recovery training applied to individuals with chronic stroke

Pigman, Jamie; Reisman, Darcy S.; Pohlig, Ryan T.; Jeka, John J.; Wright, Tamara; Conner, Benjamin C.; Petersen, Drew A.; Crenshaw, Jeremy R.

doi:10.1016/j.clinbiomech.2019.07.031

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…The presently reported changes in trunk angle at step contact following forward perturbations complement the previously reported improvements in leg angle (16). Specifically, we observed a more upright trunk position at the post-training assessment, which is in accordance with the effects of tripspecific training as reported by Pigman et al (20) and Nevisipour et al (27). Smaller forward trunk rotation angles or angular velocities are correlated with better postural stability (28,29).…”

Section: Discussionsupporting

confidence: 93%

Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke

Staring¹,

Duijnhoven²,

Roelofs³

et al. 2022

Front. Sports Act. Living

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IntroductionPeople with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT.MethodsWe performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality.ResultsWe observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle.ConclusionPBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT.

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Section: Discussionsupporting

confidence: 93%

Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke

Staring¹,

Duijnhoven²,

Roelofs³

et al. 2022

Front. Sports Act. Living

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“…All analyses were performed using SPSS version 24 with a significance level of 0.05. The sample size was estimated based on previous studies on the ActiveStep treadmill-based multi-session perturbation training paradigms, which employed 13 to 15 stroke participants [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recently, several multisession perturbation training paradigms involving an exposure to more training sessions with a greater number of perturbations have been used to improve recovery responses among individuals post-stroke [ 28 , 29 , 30 , 31 , 32 , 33 ]. These studies have demonstrated a significant improvement in the percentage of successful recovery [ 29 ], multiple stepping threshold [ 30 , 33 ], leg angles [ 31 ], steady-state gait characteristics [ 28 ], and predicted fall-risk [ 28 ], along with a decreasing trend in daily falls [ 32 ]. Additionally, a significant improvement in clinical balance measures such as the Berg Balance Scale, the Activities-Specific Balance Confidence Scale, and a reactive component of the Mini Balance Evaluation Systems Test (Mini-BESTest) were also found [ 30 , 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability

Dusane

Bhatt

2021

Brain Sciences

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Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1–6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. Results: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants’ treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). Conclusions: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS.

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“…Since patients and care givers might be more comfortable pushing the patient to trigger a reaction while sitting than in standing, this is clinically relevant information. However, perturbation-based training has been found to improve stepping responses to balance perturbations (133)(134)(135), and to be effective in the prevention of falls (136).…”

Section: The Postural Reactions Testmentioning

confidence: 99%

Assessments and Risk Factors for Falls in Persons with Acute Stroke

Sjöholm

2021

Linköping University Medical Dissertations

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Background: Early identification of risk factors is crucial for reducing the high fall risk associated with stroke, and sex differences in relation to falls need to be further investigated. There is a lack of uniform, standardized, and reliable testing procedures for postural reactions, and existing tests assessing negotiating obstacles while walking cannot be performed when walking aids are used. Aim:To investigate the predictive validity of fall risk in persons with acute stroke for easily administered data and assessments, as well as to investigate the psychometric properties of two new tests. Methods:The Postural Rections Test (PRT) and the Cone Evasion Walk Test (CEW) were developed based on literature, and on input from an expert panel. To estimate the reliability of the PRT and CEW, videorecordings of 20 persons with acute stroke performing each item in the PRT and CEW were assessed by 10 physiotherapists on two occasions, at least two weeks apart. The construct validity of the CEW (n = 221), was examined in relation to selected corresponding tests, and predictive validity by correlating the CEW to falls within six months. In 124 women and 160 men the results from the PRT and CEW, along with other easily administered data and assessments on participant characteristics, functions, and activities were analyzed in relation to the number of days to the first fall by Cox regression, while fall incidence was analyzed by negative binomial regression, both for the total cohort, and for women and men separately. Sex differences in monthly fall incidence were analyzed with Poisson regression.Results: For the intra-rater reliability of the PRT, the overall proportion of agreement was 87 − 92% for the different postural reactions, and in median 9-10 out of 10 physiotherapists scored the same value for interrater reliability. In the CEW the intra-class correlation coefficients for intra-rater and inter-rater reliability were 0.88-0.98. The results showed expected poor to moderate correlations to the selected tests for construct validity, and to falls within six months. Participants touched significantly more cones on the side that was opposite to the side of their lesion. The Cox regression analysis showed that intake of more than eight medications, paresis in the arms, paresis in the legs, impaired protective reactions in sitting, and limitations in self-care activities were decisive risk factors for the time to the first fall, and according to the negative Abstract 2 binomial regression, limitations in mobility activities was a decisive risk factor for high fall incidence in the total cohort (p<0.0005). The assessor's judgment of a person's six-month fall risk, was particularly well suited for identification of individuals with a high risk for multiple falls; however only in women when analyzed for each sex separately (p<0.0005). Compared to men, a higher number of fall risk factors were identified in women, including impaired mental functions, paresis in the arms, and limitations in several activities of self-care a...

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Anterior fall-recovery training applied to individuals with chronic stroke

Cited by 10 publications

References 39 publications

Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke

Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke

Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability

Assessments and Risk Factors for Falls in Persons with Acute Stroke

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