Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke

Abstract

BackgroundMany people with chronic stroke exhibit walking balance deficits, which are linked with increased fall risk and decreased balance confidence. One potential contributor to these deficits is a decreased ability to adjust where the paretic foot is placed based on pelvis motion, which is an important factor in mediolateral walking balance.ObjectiveThe objective of this study was to investigate altered stepping behavior for steps taken with the paretic leg, and to explore the relationship between this behavior and clinical measures of balance and balance confidence.Methods.93 individuals with chronic stroke walked on a treadmill and completed a series of common clinical tests. We used partial correlations to quantify the step-by-step relationship between mediolateral pelvis displacement and both step width (ρSW) and mediolateral foot placement relative to the pelvis (ρFP), a metric that focuses on swing leg repositioning.ResultsρSW was weaker for steps taken with the paretic leg, whereas ρFP did not differ between non-paretic and paretic steps. Participants who walked faster had larger ρSW and ρFP values, but instructing participants to walk faster did not consistently increase ρSW or ρFP for paretic steps. Significant, albeit weak, relationships were observed between paretic ρSW and Functional Gait Assessment score, as well as between paretic ρFP and Activities-Specific Balance Confidence score, fear of falling, and fall history.ConclusionsA reduced ability to adjust where the paretic foot lands when taking a step may discourage fast walking speeds after a stroke and contribute to clinical observations of decreased walking balance.

Force-field perturbations and muscle vibration strengthen stability-related foot placement responses during steady-state gait

“…Since the current study aims at giving better insight into what earlier found improvements in the degree of foot placement control [12, 17] reflect, as well as whether the effects of sensory augmentation and force-field perturbations could complement each other, further investigating the relationship with gait stability is beyond the scope of this study. Another study, has already established a link between foot placement outcome measures and clinical outcome measures [25]. Future work is needed to gain more insight into which (foot placement) outcome measures should improve for a gait stability training to be effective.…”