Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation?

Mansfield, Avril; Inness, Elizabeth L.; Wong, Joseph; Fraser, Julia; McIlroy, William E.

doi:10.1177/1545968313478486

Cited by 84 publications

(75 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, falls risk for individuals with stroke is doubled relative to healthy older adults [2]. Balance confidence, or an individual's confidence in their ability to maintain balance and remain steady [3], has been related to falls risk in community-dwelling individuals with stroke [4], as has falls-related self-efficacy [5,6]. Therefore, it is important to establish the nature of the relationships between balance confidence and falls risk in this population.…”

Section: Introductionmentioning

confidence: 99%

“…Between-limb synchronization during quiet standing, variability during walking, and reactive stepping measures have been related to falls in individuals with stroke [6,12]. Measures such as COP excursion during eyes-open quiet standing, walking velocity, and double support time are related to falls in older adults [13][14][15], as is postural sway during eyes-closed quiet standing in individuals with multiple sclerosis [16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

Schinkel-Ivy

Wong

Mansfield

2017

Journal of Stroke and Cerebrovascular Diseases

Self Cite

View full text Add to dashboard Cite

Reduced balance confidence is associated with impairments in features of balance and gait in individuals with sub-acute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months post-discharge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. Walking velocity was positively correlated with balance confidence, while medio-lateral centre of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

Schinkel-Ivy

Wong

Mansfield

2017

Journal of Stroke and Cerebrovascular Diseases

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although it is well-known that there is a decline in dualtask function post-stroke [28][29][30][31][32][33], most studies have reported CMI during a single motor task such as gait, quiet standing, or voluntary stepping. Furthermore, no study thus far has examined CMI during compensatory stepping from large perturbations which is impaired in this population [34,35]. Hyndman et al (2006) compared the CMI during quiet standing and walking and observed that a concurrent cognitive task affected on walking speed but not anteoposterior sway during standing, suggesting that a simple task like standing may not be affected by a cognitive task among chronic stroke survivors [36].…”

Section: Effect Of Stroke On CMI Across Balance Tasksmentioning

confidence: 99%

Attentional Demands of Locomotor and Balance Tasks in Individuals Aging with and without a Stroke

Patel¹,

Bhatt²

2017

Int J Phys Ther Rehabil

View full text Add to dashboard Cite

Background: The purpose of this study was to examine the cognitive-motor interference pattern while concurrently performing a higher cognitive task with three dynamic postural tasks -limits of stability (intentional balance), compensatory stepping during (reactive balance -RB) and walking tasks across younger adults (YA), older adults (OA) and older chronic stroke survivors.Methods: Thirty-six individuals in each group performed either of the three postural tasks -forward limits of stability (LOS, intentional balance), forward compensatory stepping (reactive balance -RB) and walking task (gait) with (dual-task) and without (single-task) performing a serial subtraction (SS) task. The SS tasks was also performed in isolation. Maximum center of pressure excursion (MXE) for LOS, center of mass position relative to base of support at step touchdown for RB, gait velocity and number of correct responses for SS task were measured. Motor and cognitive costs were calculated. Results:The healthy adults showed higher motor cost for more dynamic gait and RB tasks compared with the LOS task however, motor costs were similar for all the tasks in the stroke group. Although the motor cost for OA and stroke groups were more than YAs for all postural tasks, motor cost was significantly greater in stroke group than OA group only for the LOS task. Conclusion:The attentional demands are higher for postural task that are biomechanically unstable in healthy adults. Chronic stroke survivors show disproportionate ability to divide attention seen by higher motor cost during LOS task. Nevertheless, in chronic phase of recovery, stroke survivors may regain some dual-task function displaying similar strategies as healthy counterparts. Int J Phys Ther RehabIJPTR, an open access journal

show abstract

“…A critical factor underlying falls is the lack of ability to recover from a loss of balance, specifically using a rapid stepping response [2]. Reactive stepping performance is predictive of falls among communityliving elderly [3,4], associated with falls among those with stroke in inpatient rehabilitation [5] and predictive of falls after discharge to the community [6].…”

Section: Introductionmentioning

confidence: 99%

Clinical implementation of a reactive balance control assessment in a sub-acute stroke patient population using a ‘lean-and-release’ methodology

et al. 2015

Self Cite

View full text Add to dashboard Cite

Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation?

Cited by 84 publications

References 33 publications

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

Attentional Demands of Locomotor and Balance Tasks in Individuals Aging with and without a Stroke

Clinical implementation of a reactive balance control assessment in a sub-acute stroke patient population using a ‘lean-and-release’ methodology

Contact Info

Product

Resources

About