Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity

Abstract

Background After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. Objective. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls. Methods An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment—Lower Extremity (range: 0-28). Results Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration. Conclusions Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.

Translational Medicine in Acute Ischemic Stroke and Traumatic Brain Injury—NeuroAiD Trials, from Traditional Beliefs to Evidence-Based Therapy

“…Likewise, the correlation between AIS and susceptibility to head trauma is well exemplified. An observational study of individuals who experienced a minor AIS showed that these individuals were more than twice as likely to experience falls compared to healthy controls [ 109 ]. This study highlights the potential repercussions of a minor AIS on aspects such as balance and gait capacity, confidence in balance, risk of falling, and daily physical activities.…”

“…A noteworthy finding from this study is that even individuals who had fully recovered displayed inferior balance and walking capacities compared to healthy controls. These results suggest that balance and walking ability after a minor AIS could be influenced by clinically imperceptible leg motor impairments or higher-level sensorimotor coordination, both of which pose a substantial risk for falls [ 109 ]. With twice more falls in this mild AIS cohort, the balance and gait impairments are clinically relevant.…”

Clinical Effect Analysis of Wearable Sensor Technology-Based Gait Function Analysis in Post-Transcranial Magnetic Stimulation Stroke Patients

“…The impairment of walking and balance functions represents one of the most common clinical manifestations of stroke, significantly increasing the risk of falls among stroke patients [5], thereby profoundly affecting their quality of life and their ability to reintegrate into society [6]. Therefore, restoring the walking ability of patients stands out as a primary objective in stroke rehabilitation.…”