Does aging with a cortical lesion increase fall-risk: Examining effect of age versus stroke on intensity modulation of reactive balance responses from slip-like perturbations

Patel, Prakruti; Bhatt, Tanvi

doi:10.1016/j.neuroscience.2016.06.044

Cited by 23 publications

(34 citation statements)

References 53 publications

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“…Due to the longer latency of its occurrence (>150 ms post perturbation onset), it has been postulated that the later motor component of the balance reaction is actively influenced by inputs from higher brain centers, including the cerebral cortex. This is further supported by the presence of severe balance impairments in humans with cortical damage, such as after cortical stroke (Lin et al, 2014;Patel & Bhatt, 2016;Pérennou et al, 2000), and the deterioration of reactive balance function that occurs when the cortex is engaged in simultaneous performance of a cognitive dual task (Bolton et al, 2011;Jacobs & Horak, 2007;B. E. Maki & McIlroy, 2007).…”

Section: Introductionmentioning

confidence: 97%

Cortical beta oscillatory activity evoked during reactive balance recovery scales with perturbation difficulty and individual balance ability

Ghosn

Palmer

Borich

et al. 2020

Preprint

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I.AbstractCortical beta oscillations (13-30 Hz) reflect sensorimotor cortical activity, but have not been fully investigated in balance recovery behavior. We hypothesized that more challenging balance conditions would lead to greater recruitment of cortical sensorimotor brain regions for balance recovery. We predicted that beta power would be enhanced when balance recovery is more challenging, either due to more difficult perturbations or due to lower intrinsic balance ability. In 19 young adults, we measured beta power evoked over motor cortical areas (Cz electrode) during 3 magnitudes of backward support-surface translational perturbations using electroencephalography. Peak beta power was measured during early (50-150 ms), late (150-250 ms), and overall (0-400 ms) time bins, and wavelet-based analyses quantified the time course of evoked beta power and agonist and antagonist ankle muscle activity. We further assessed the relationship between individual balance ability measured in a challenging beam walking task and perturbation-evoked beta power within each time bin. In balance perturbations, cortical beta power increased ∼50 ms after perturbation onset, demonstrating greater increases with increasing perturbation magnitude. Balance ability was negatively associated with peak beta power in only the late (150-250 ms) time bin, with higher beta power in individuals who performed worse in the beam walking task. Additionally, the time course of cortical beta power followed a similar waveform as the evoked muscle activity, suggesting these evoked responses may be initially evoked by shared underlying mechanisms. These findings support the active role of sensorimotor cortex in balance recovery behavior, with greater recruitment of cortical resources under more challenging balance conditions. Cortical beta power may therefore provide a biomarker for engagement of sensorimotor cortical resources during reactive balance recovery and reflect the individual level of balance challenge.

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Section: Introductionmentioning

confidence: 97%

Cortical beta oscillatory activity evoked during reactive balance recovery scales with perturbation difficulty and individual balance ability

Ghosn

Palmer

Borich

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…PwCS have demonstrated failure to modulate reactive responses upon exposure to novel, increasing perturbation intensities compared with age-matched healthy older adults [20]. However, we found that reactive balance training could enhance the ability to modulate recovery response to a higher perturbation intensity.…”

Section: Discussionmentioning

confidence: 56%

“…Studies examining reactive responses to stance perturbations in PwCS have reported delayed onset latencies of lower extremity muscles, with smaller amplitude and altered sequence of activation [12, 13]. Moreover, PwCS often show delayed compensatory step initiation with a short compensatory step, or they exhibit an aborted step or multiple stepping responses; all of which compromise postural stability and increase fall-risk [14–20].…”

Section: Introductionmentioning

confidence: 99%

Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

Bhatt

Dusane

Patel

2019

J NeuroEngineering Rehabil

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BackgroundA single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment.MethodsTwenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed.ResultsOn the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control.ConclusionChronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity.

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“…Insight in key determinants of successful balance recovery is crucial for identifying stroke survivors at risk of falling. Previous studies have identified stroke-related deficits in reactive step kinematics as well as determinants of successfulness of balance recovery in people after stroke [ 4 – 6 , 8 , 10 , 19 ]. Our findings add to these previous observations by identifying a set of key parameters that are most critical for successful balance recovery following backward balance perturbations.…”

Section: Discussionmentioning

confidence: 99%

“…Such stepping responses are substantially impaired in people after stroke compared to healthy individuals [ 4 – 9 ]. When exposed to balance perturbations in a laboratory situation, people after stroke demonstrated later and smaller steps and their center of mass (COM) was closer to the boundaries of their base of support (BOS) at the moment of first foot contact [ 5 , 8 ]. Deficits in step kinematics (i.e.…”

Section: Introductionmentioning

confidence: 99%

Body configuration at first stepping-foot contact predicts backward balance recovery capacity in people with chronic stroke

et al. 2018

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ObjectiveTo determine the predictive value of leg and trunk inclination angles at stepping-foot contact for the capacity to recover from a backward balance perturbation with a single step in people after stroke.MethodsTwenty-four chronic stroke survivors and 21 healthy controls were included in a cross-sectional study. We studied reactive stepping responses by subjecting participants to multidirectional stance perturbations at different intensities on a translating platform. In this paper we focus on backward perturbations. Participants were instructed to recover from the perturbations with maximally one step. A trial was classified as ‘success’ if balance was restored according to this instruction. We recorded full-body kinematics and computed: 1) body configuration parameters at first stepping-foot contact (leg and trunk inclination angles) and 2) spatiotemporal step parameters (step onset, step length, step duration and step velocity). We identified predictors of balance recovery capacity using a stepwise logistic regression. Perturbation intensity was also included as a predictor.ResultsThe model with spatiotemporal parameters (perturbation intensity, step length and step duration) could correctly classify 85% of the trials as success or fail (Nagelkerke R2 = 0.61). In the body configuration model (Nagelkerke R2 = 0.71), perturbation intensity and leg and trunk angles correctly classified the outcome of 86% of the recovery attempts. The goodness of fit was significantly higher for the body configuration model compared to the model with spatiotemporal variables (p<0.01). Participant group and stepping leg (paretic or non-paretic) did not significantly improve the explained variance of the final body configuration model.ConclusionsBody configuration at stepping-foot contact is a valid and clinically feasible indicator of backward fall risk in stroke survivors, given its potential to be derived from a single sagittal screenshot.

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Does aging with a cortical lesion increase fall-risk: Examining effect of age versus stroke on intensity modulation of reactive balance responses from slip-like perturbations

Cited by 23 publications

References 53 publications

Cortical beta oscillatory activity evoked during reactive balance recovery scales with perturbation difficulty and individual balance ability

Cortical beta oscillatory activity evoked during reactive balance recovery scales with perturbation difficulty and individual balance ability

Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

Body configuration at first stepping-foot contact predicts backward balance recovery capacity in people with chronic stroke

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