Relationships between fear of falling, balance confidence, and control of balance, gait, and reactive stepping in individuals with sub-acute stroke

Abstract

Fear of falling is common in individuals with stroke; however, the associations between fear of falling, balance confidence, and the control of balance and gait are not well understood for this population. This study aimed to determine whether, at the time of admission to in-patient rehabilitation, specific features of balance and gait differed between individuals with stroke who did and did not report fear of falling, and whether these features were related to balance confidence. Individuals with stroke entering in-patient rehabilitation were asked if they were afraid of falling, and completed the Activities-Specific Balance Confidence Scale. Participants performed quiet standing, gait, and reactive stepping tasks, and specific measures were extracted for each (quiet standing: centre of pressure amplitude, between-limb synchronization, and Romberg quotients; gait: walking velocity, double support time, and variability measures; reactive stepping: number of steps, frequency of grasp reactions, and frequency of assists). No significant differences were identified between individuals with and without fear of falling. Balance confidence was negatively related to centre of pressure amplitude, double support time, and step time variability, and positively related to walking velocity. Low balance confidence was related to poor quiet standing balance control and cautious behavior when walking in individuals with sub-acute stroke. While the causal relationship between balance confidence and the control of balance and gait is unclear from the current work, these findings suggest there may be a role for interventions to increase balance confidence among individuals with stroke, in order to improve functional mobility.

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

“…As part of the larger study, participants were invited to complete a clinical assessment of balance and gait at 6 months post-discharge from in-patient rehabilitation if they had completed the same assessment at discharge from in-patient rehabilitation; had been discharged home from in-patient rehabilitation; and were capable of independent ambulation at discharge [12]. Individuals were included in the current analysis if they completed the ABC Scale [3] and at least one of the following tasks in the 6-month assessment: quiet standing, self-paced walking without a walking aid across a pressure-sensitive mat, and/or an unconstrained lean-and-release reactive stepping trial (assessment details below) [11,12]. Initially, 100 individuals were recruited, with 69 of those individuals returning for a follow-up assessment.…”

“…In individuals with stroke, falls self-efficacy has been positively related to clinical balance and gait outcomes [10]. Recently, relationships between balance confidence and specific features of balance and gait were assessed in individuals with sub-acute stroke [11]. Balance confidence was positively related to walking velocity, and negatively related to antero-posterior COP excursion (antero-posterior direction) during quiet standing and double support time and step time variability during walking [11].…”

“…Recently, relationships between balance confidence and specific features of balance and gait were assessed in individuals with sub-acute stroke [11]. Balance confidence was positively related to walking velocity, and negatively related to antero-posterior COP excursion (antero-posterior direction) during quiet standing and double support time and step time variability during walking [11]. These results suggest that in individuals with subacute stroke, low balance confidence was associated with impaired control of quiet standing balance and cautious behaviour during gait [11].…”

“…While balance confidence and features of gait and balance have been related in individuals with sub-acute stroke [11], one limitation of this study was that the assessments were administered soon after stroke (when participants were admitted to inpatient rehabilitation). The Activities-Specific Balance Confidence (ABC) Scale asks participants to assess confidence in completing activities that individuals in in-patient rehabilitation may not have attempted since their strokes (e.g., walking in a crowded environment or on icy surfaces) [11].…”

“…The Activities-Specific Balance Confidence (ABC) Scale asks participants to assess confidence in completing activities that individuals in in-patient rehabilitation may not have attempted since their strokes (e.g., walking in a crowded environment or on icy surfaces) [11]. Therefore, it may have been challenging for participants to quantify their levels of balance confidence at that time point in their stroke recovery.…”