Falls-risk post-stroke: Examining contributions from paretic versus non paretic limbs to unexpected forward gait slips

Kajrolkar, Tejal; Bhatt, Tanvi

doi:10.1016/j.jbiomech.2016.06.005

Cited by 27 publications

(28 citation statements)

References 32 publications

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“…Biomechanically, the mediolateral foot position relative to the horizontal location of the CoM WB established at foot-strike is the most important factor affecting the frontal plane whole-body balance during gait (Mackinnon & Winter, 1993). The larger MoS measured on the non-paretic side may indicate that post-stroke participants "overstepped" laterally with their non-paretic foot, to recover from the instability of the paretic side stance phase (Hendrickson et al, 2014;Kajrolkar & Bhatt, 2016;Nott et al, 2014). This "overstep" strategy used to improve dynamic stability could contribute to the observations reported in post-stroke individuals such as reduced walking velocity ( Figure A, supplementary materials), increased time spent on the non-paretic foot (Chen et al, 2005;Melzer et al, 2010;Olney & Richards, 1996;Patterson et al, 2008), increased lateral oscillations (Chen et al, 2005;De Bujanda et al, 2004;Hak et al, 2013;Melzer et al, 2010) and increased fatigability (Kuo, 2001).…”

Section: Post-stroke Participants Increased Dynamic Stability Asymmetmentioning

confidence: 99%

“…But the consequence of a reduced instability in the non-paretic limb stance phase is a larger lateral balance recovery on the paretic-limb's side during the following double-support phase. Because balance recovery is more difficult for post-stroke individuals than for healthy controls, especially on their paretic limb's side due to their deficits (Kajrolkar & Bhatt, 2016), the locomotor adaptations undertaken by post-stroke participants in dual-tasks (Beyaert et al, 2015;Cockburn et al, 2003;Plummer et al, 2013) may be used to ensure sufficient stability while walking.…”

Section: 2dual-tasking Modulates the Dynamic Stability Strategy Ofmentioning

confidence: 99%

“…Hence, the apparent consistency in mediolateral dynamic stability observed in post-stroke participants during dual-tasks may result from adaptations of their locomotor pattern and is cognitively onerous (Beyaert et al, 2015;Cockburn et al, 2003;Plummer et al, 2013). Post-stroke individuals have poorer dynamic balance than healthy controls in locomotor/stepping activity (Kajrolkar & Bhatt, 2016;Nott et al, 2014;Vistamehr et al, 2016).…”

Section: 2dual-tasking Modulates the Dynamic Stability Strategy Ofmentioning

confidence: 99%

“…Secondly, the MoS does not give information about forces segmental inertial momentums and the rotation movements involved during gait that could influence the dynamic balance of stroke participants (Vistamehr et al, 2016). Finally, while measure of MoS provided insights to dynamic balance and potential adaptations to instability during post-stroke gait, impaired reactive responses may also contribute to the increased prevalence of falls during post-stroke gait (Kajrolkar & Bhatt, 2016;Lakhani, Mansfield, Inness, & McIlroy, 2011). Thus, balance instability captured with MoS in this study does not allow us to conclude on the ability of MoS to capture impaired reactive balance control responses that may happen during post-stroke gait.…”

Section: 3study Limitationsmentioning

confidence: 99%

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Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals

Tisserand

Armand

Allali

et al. 2018

Human Movement Science

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Gait asymmetry and dynamic balance impairments observed in post-stroke individuals increase their risk of fall. Moreover, walking while performing a cognitive task (i.e. dual-task) disturbs the control of balance in post-stroke individuals. Here we investigated the mediolateral dynamic stability in twenty-two community-dwelling participants (12 post-strokes and 10 healthy controls) while walking in single-task (normal gait) and four different dual-tasks (cognitive-motor interference). Positions of the extrapolated center of mass and mediolateral widths of both margin of stability and base of support were extracted from 35 marker trajectories. Post-stroke participants presented larger margin of stability and base of support than controls during single-task (both p < 0.01), with a larger margin of stability on the non-paretic side than on the paretic side at ipsilateral foot-strike (p < 0.05). No significant effect of the dual-task was found between groups. In post-stroke participants, dual-task induced slight modification of the mediolateral stability strategy, as the margin of stability was not different between the two limbs at foot-strike, and significantly reduced the performance in every cognitive task. Post-stroke participants increased their dynamic stability in the frontal plane in single-task by extending their base of support and mainly relying on their non-paretic limb. Under cognitive-motor interference (dual-task), post-stroke participants prioritized dynamic stability over cognitive performance to ensure a safe locomotion. Thus, rehabilitation programs should consider both dynamic balance and dual-task training, even at a chronic delay following stroke, to reduce the risk of fall in post-stroke individuals.

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Section: Post-stroke Participants Increased Dynamic Stability Asymmetmentioning

confidence: 99%

Section: 2dual-tasking Modulates the Dynamic Stability Strategy Ofmentioning

confidence: 99%

Section: 2dual-tasking Modulates the Dynamic Stability Strategy Ofmentioning

confidence: 99%

Section: 3study Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals

Tisserand

Armand

Allali

et al. 2018

Human Movement Science

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“…However, individuals with hemiparesis have impairments that affect one side of the body. They may be unable to balance their body weight equally on each foot, and this causes a greater fall risk on the paretic side during whole-body movements (Kajrolkar & Bhatt, 2016). Therefore, prioritizing mediolateral dynamic balance control might have different implications for individuals with hemiparesis compared with healthy individuals.…”

mentioning

confidence: 99%

Sensorimotor Strategies in Individuals With Poststroke Hemiparesis When Standing Up Without Vision

2020

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This study investigated the sensorimotor strategies for dynamic balance control in individuals with stroke by restricting sensory input that might influence task accomplishment. Sit-to-stand movements were performed with restricted vision by participants with hemiparesis and healthy controls. The authors evaluated the variability in the position of participants’ center of mass and velocity, and the center-of-pressure position, in each orthogonal direction at the lift-off point. When vision was restricted, the variability in the mediolateral center-of-pressure position decreased significantly in individuals with hemiparesis, but not in healthy controls. Participants with hemiparesis adopted strategies that explicitly differed from those used by healthy individuals. Variability may be decreased in the direction that most requires accuracy. Individuals with hemiparesis have been reported to have asymmetrical balance deficits, and that meant they had to prioritize mediolateral motion control to prevent falling. This study suggests that individuals with hemiparesis adopt strategies appropriate to their characteristics.

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Fall risk during opposing stance perturbations among healthy adults and chronic stroke survivors

Patel

Bhatt

2017

Exp Brain Res

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Studies examining recovery from SLIPS and TRIPS indicate higher incidence of falls during SLIPS than TRIPS however, differences in the recovery mechanisms during these opposing perturbations have not been examined. We therefore aimed to compare the reactive balance responses contributing to fall risk during SLIPS and TRIPS at comparable perturbation intensity among community-dwelling healthy adults and chronic stroke survivors. Younger adults (N = 11), age-matched adults (N = 11) and chronic stroke survivors (N = 12) were exposed to a single SLIP and TRIP through a motorized treadmill (16 m/s 0.20 m). Center of mass (COM) state stability was measured by recording COM position and velocity relative to base of support, i.e., Ḋ and Ẋ, respectively. Trunk and compensatory step kinematics were also recorded. During SLIPS, the incidence of falls among stroke survivors was greater than healthy adults (53.83% vs. 0%), however not for TRIPS. All groups showed higher change in postural stability from liftoff to touchdown during TRIPS than SLIPS. Among healthy adults higher change in Ḋ during TRIPS was accompanied by the ability to control trunk flexion at step touchdown and lower peak trunk velocity as compared with SLIPS, with no significant differences in compensatory step length between the perturbations (p> 0.05). Chronic stroke survivors increased compensatory step length during TRIPS versus SLIPS (p < 0.05) contributing to greater stability change. They were unable to control trunk excursion and peak trunk velocity as compared with the healthy adults leading to lower stability than healthy younger and age-matched adults during SLIPS and lower stability than younger adults during TRIPS. Difficulty in trunk control during SLIPS among all individuals and compensatory step length among stroke survivors emphasizes higher fall risk for SLIPS than TRIPS among these populations.

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Falls-risk post-stroke: Examining contributions from paretic versus non paretic limbs to unexpected forward gait slips

Cited by 27 publications

References 32 publications

Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals

Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals

Sensorimotor Strategies in Individuals With Poststroke Hemiparesis When Standing Up Without Vision

Fall risk during opposing stance perturbations among healthy adults and chronic stroke survivors

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