Do measures of reactive balance control predict falls in people with stroke returning to the community?

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

doi:10.1016/j.physio.2015.01.009

Cited by 111 publications

(109 citation statements)

References 35 publications

(48 reference statements)

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“…This study involved secondary analysis of a prospective cohort study, 19 which aimed to determine if measures of reactive balance control, as assessed at discharge from in-patient rehabilitation, predicted falls in the six months post-discharge among individuals with stroke. Recruitment took place on the stroke rehabilitation unit at the Toronto Rehabilitation Institute -University Health Network between October 20, 2010 andMarch 21, 2013.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation

Wong

Brooks

Inness

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Section: Methodsmentioning

confidence: 99%

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation

Wong

Brooks

Inness

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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“…This study involved cross-sectional, retrospective review of data from individuals with stroke who underwent in-patient stroke rehabilitation at a rehabilitation hospital between September 2010 and March 2013 [12,17]. 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].…”

Section: Participantsmentioning

confidence: 99%

“…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.…”

Section: Participantsmentioning

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%

“…Between-limb synchronization during quiet standing, variability during walking, and reactive stepping measures have been related to falls in individuals with stroke [6,12]. Measures such as COP excursion during eyes-open quiet standing, walking velocity, and double support time are related to falls in older adults [13][14][15], as is postural sway during eyes-closed quiet standing in individuals with multiple sclerosis [16].…”

Section: Introductionmentioning

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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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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Do measures of reactive balance control predict falls in people with stroke returning to the community?

Cited by 111 publications

References 35 publications

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation

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

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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