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

Abstract

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.

Relationships between gait variability and ambulatory activity post stroke

“…The higher stride duration variability observed in less active individuals could be due to poorer self-efficacy for balance. 9,15,16 Individuals with poor balance confidence tend to focus more on their travel path while walking and less on potential obstacles in their path, 25 limiting their ability to anticipate necessary path adjustments to avoid pedestrians or obstacles. Therefore, gait variability may have been increased by the need to make more sudden, larger amplitude adjustments in stepping.…”

“…6 However, including measures of both walking ability and balance confidence in a predictive model still does not fully explain variance in ambulatory activity. 9 Gait variability, a measure of walking ability with a known association with fall risk and balance confidence, [14][15][16] may be a strong single predictor of ambulatory activity.…”

“…Gait variability is often quantified in terms of stride length and stride duration variability, both of which have been related to fall risk 14 and balance confidence 15,16 post-stroke. Specifically, increased step length variability predicted increased fall rates (multivariate Poisson regression rate ratio 1.4; 95% CI 1.2 to 1.7; p=0.001) 14 in community-dwelling individuals post-stroke after discharge from inpatient rehabilitation.…”

“…Specifically, increased step length variability predicted increased fall rates (multivariate Poisson regression rate ratio 1.4; 95% CI 1.2 to 1.7; p=0.001) 14 in community-dwelling individuals post-stroke after discharge from inpatient rehabilitation. More recently, Schinkel-Ivy et al 15,16 observed that individuals post-stroke with more variable temporal step characteristics had lower confidence in their balance, leading them to suggest that greater step duration variability may be associated with more reactive, and thus, less efficient balance control. The relationship between gait variability to fall risk and balance confidence suggests that gait variability may be a strong predictor of ambulatory activity, but the relationship between gait variability and ambulatory activity post-stroke is currently unknown.…”

Dynamic feet distance: A new functional assessment during treadmill locomotion in normal and thoracic spinal cord injured rats

“…Neurological affected humans with reduced sensory information from the lower limbs and poor muscle strength to control leg movements also show wider step width [17]. Many studies have suggested that medial-lateral stability is very important for people to maintain balance and avoid falling [18]. The step width variability represents the more sensitive descriptor of locomotion control of older and young adults.…”