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

Inness, Elizabeth L.; Mansfield, Avril; Biasin, Louis; Brunton, Karen; Bayley, Mark; McIlroy, William E.

doi:10.1016/j.gaitpost.2014.12.005

Cited by 43 publications

(35 citation statements)

References 26 publications

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“…Of the 19 participants who were not included in the reactive stepping analysis, nine participants attempted at least one trial but were excluded from the analysis due to an insufficient load on the release cable. Alternative reasons for the lower participation rate in the reactive stepping assessment may have included insufficient tolerance for exercise or physical activity, current pain or musculoskeletal disorder, participants' preference or refusal of the assessment, and participants' anxiety [23]. Therefore, it is possible that the participants who did not complete the reactive stepping component of the assessment had poor balance control.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

“…Reactive stepping: A lean-and-release system was used to assess reactive stepping ability in response to an external perturbation [12,23]. Participants wore a safety harness during the trials to prevent a fall to the floor if the participant was unable to recover balance.…”

Section: Clinical Balance Assessmentmentioning

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

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“…As part of the in-patient stroke rehabilitation program, clinical assessments of reactive balance control were included as routine care during individuals’ stay, conducted by one of four on-site physiotherapists [19]. However, components of the assessment may not have been conducted for every individual (at the physiotherapists’ discretion).…”

Section: Methodsmentioning

confidence: 99%

“…The reactive balance component is among the most difficult of the clinical assessment. Potential reasons for the low participation rate for this component include: individuals’ anxiety or refusal of the reactive stepping component; low physical activity tolerance; pain or a musculoskeletal disorder that may have been exacerbated by the reactive stepping component; and/or other health or medical factors [19]. Individuals may also have been unable or reluctant to lean forward to complete the test.…”

Section: Methodsmentioning

confidence: 99%

“…Reactive stepping was assessed using a lean-and-release method [13, 19, 24, 25, 26], within a single session. Participants wore their usual flat closed-toe footwear and ankle-foot orthoses, if prescribed [27], and were outfitted with a safety harness attached to an overhead track, which acted to prevent a fall to the floor in the event of a failure to recover balance following the perturbation.…”

Section: Methodsmentioning

confidence: 99%

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Timing of reactive stepping among individuals with sub-acute stroke: effects of ‘single-task’ and ‘dual-task’ conditions

Schinkel-Ivy

Huntley

Inness

et al. 2016

Heliyon

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Performance decrements in balance tasks are often observed when a secondary cognitive task is performed simultaneously. This study aimed to determine whether increased cognitive load resulted in altered reactive stepping in individuals with sub-acute stroke, compared to a reactive stepping trial with no secondary task. The secondary purpose was to determine whether differences existed between the first usual-response trial, subsequent usual-response trials, and the dual-task condition. Individuals with sub-acute stroke were exposed to external perturbations to elicit reactive steps. Perturbations were performed under a usual-response (single-task) and dual-task condition. Measures of step timing and number of steps were based on force plate and video data, respectively; these measures were compared between the usual-response and dual-task trials, and between the first usual-response trial, later usual-response trials (trials 2–5) and a dual-task trial. A longer time of unloading onset and greater number of steps were identified for the first usual-response trial compared to later usual-response trials. No significant differences were identified between usual-response and dual-task trials. Although improvements were observed from the first to subsequent usual-response lean-and-release trials, performance then tended to decrease with the introduction of the dual-task condition. These findings suggest that when introduced after usual-response trials, the dual-task trial may represent the first trial of a new condition, which may be beneficial in reducing the potential for adaptation that may occur after multiple repetitions of a reactive stepping task. Therefore, these findings may lend support to the introduction of a new condition (i.e. a dual-task trial) in addition to usual-response trials when assessing reactive balance in individuals with stroke.

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Clinical assessment of reactive balance control in acquired brain injury: A comparison of manual and cable release‐from‐lean assessment methods

Borrelli

Junod

Inness

et al. 2019

Physiotherapy Res Intl

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Objective Perturbation‐evoked stepping reactions are infrequently assessed directly in clinical settings even though stepping reactions in response to a sudden loss‐of‐balance perturbation ultimately determine whether a fall occurs. Individuals with acquired brain injury (ABI) due to stroke who are ambulatory and awaiting hospital discharge have been found to exhibit delayed stepping reactions but are typically discharged without assessment of perturbation‐evoked stepping. Tests that specifically target the capacity to perform perturbation‐evoked stepping reactions are important to identify those at risk for falls and to direct intervention strategies. The aim of this study was to evaluate agreement and reliability of two assessment methods used to assess rapid stepping reactions, specifically in individuals with ABI due to stroke or other causes. A secondary aim was to compare perturbation‐triggered biomechanics of the two assessment methods. Methods Thirty‐five participants who were less than 4 months post‐ABI were evaluated in an inpatient unit at the Toronto Rehabilitation Institute. Stepping reactions were assessed using manual release‐from‐lean and cable release‐from‐lean perturbation‐based assessment methods. Results There was moderate agreement between the assessment scores resulting from the two assessment methods (κ = 0.55) and substantial test–retest reliability (κ's > 0.61) for both assessment methods. There was no evidence that the assessment score was affected by assessment method, test–retest, or assessment order. However, the cable release from lean resulted in a more rapid release of the lean support force (2 ms vs. 125 ms) and earlier foot‐off times (340 ms vs. 401 ms) compared with the manual release from lean. Conclusion Delays in foot‐off time associated with the manual release‐from‐lean perturbation raise concerns that the manual assessment method may not provide a perturbation that is sufficiently challenging to reveal a patient's balance‐recovery capacity and associated fall risk. However, the manual assessment requires no equipment and the assessment score may provide a useful indication of gross reactive balance control.

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

Cited by 43 publications

References 26 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

Timing of reactive stepping among individuals with sub-acute stroke: effects of ‘single-task’ and ‘dual-task’ conditions

Clinical assessment of reactive balance control in acquired brain injury: A comparison of manual and cable release‐from‐lean assessment methods

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