Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

Bower, Kelly J; Thilarajah, Shamala; Pua, Yong-Hao; Williams, Gavin; Tan, Dawn; Mentiplay, Benjamin F.; Denehy, Linda; Clark, Ross

doi:10.1186/s12984-018-0478-4

Cited by 87 publications

(100 citation statements)

References 64 publications

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“…As the other perturbation directions are concerned weak and statistically insignificant relations were found indicating that these outcome measures do not provide information on abilities to appropriately react to unexpected loss of balance during slow walking in the backward, inward and outward directions. Some prospective studies have suggested that the TUG clinical outcome measure may be a good predictor of a potential fall in the stroke population [16,32]. The results of our study have shown that TUG was to some extent related to the abilities of the tested group of post-stroke subjects to react to forward and backward perturbations where the obtained Spearman correlation coefficients were statistically significant.…”

Section: Clinical Outcome Measuressupporting

confidence: 66%

“…There are no clinical outcome measures to assess the ability of post-stroke subjects to cope with unexpected perturbations during walking. Fall risk prediction was often addressed in relation to various clinical outcome measures, which provide information about the performance of post-stroke subjects in terms of motor abilities and cognitive aspects [15][16][17]. The Timed-Up-and-Go test (TUG), 10-Meter Walk Test (10MWT) and Functional Independence Measure (FIM) were suggested as reliable and valid assessment tools for predicting falls in moderately-functioning post-stroke subjects [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

J NeuroEngineering Rehabil

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Background: Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. Methods: Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. Results: The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.

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Section: Clinical Outcome Measuressupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

J NeuroEngineering Rehabil

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“…Whereas other parameters of gait variability are usually enhanced in fallers vs. non-fallers in healthy elderly fallers 2,3,[5][6][7][8][9][10]42 , mediolateral variability of the COP was reduced in fallers vs. non fallers in our study. This finding conforms to a previous study that investigated mediolateral gait dynamics during walking in stroke survivors: the authors reported reduced mediolateral pelvis displacement in fallers vs. non-fallers with chronic stroke 43 . Reduced mediolateral variability might be an adaptation to stabilize the gait pattern which is also found in fall-prone populations other than stroke patients.…”

Section: Discussionsupporting

confidence: 92%

Fall-related functional impairments in patients with neurological gait disorder

Ehrhardt

Hostettler

Widmer

et al. 2020

Sci Rep

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Falls are common in patients with neurological disorders and are a primary cause of injuries. Nonetheless, fall-associated gait characteristics are poorly understood in these patients. Objective, quantitative gait analysis is an important tool to identify the principal fall-related motor characteristics and to advance fall prevention in patients with neurological disorders. Fall incidence was assessed in 60 subjects with different neurological disorders. Patients underwent a comprehensive set of functional assessments including instrumented gait analysis, computerized postural assessments and clinical walking tests. Determinants of falls were assessed by binary logistic regression analysis and receiver operator characteristics (ROC). The best single determinant of fallers was a step length reduction at slow walking speed reaching an accuracy of 67.2% (ROC AUC: 0.669; p = 0.027). The combination of 4 spatio-temporal gait parameters including step length and parameters of variability and asymmetry were able to classify fallers and non-fallers with an accuracy of 81.0% (ROC AUC: 0.882; p < 0.001). These findings suggest significant differences in specific spatio-temporal gait parameters between fallers and non-fallers among neurological patients. Fall-related impairments were mainly identified for spatio-temporal gait characteristics, suggesting that instrumented, objective gait analysis is an important tool to estimate patients' fall risk. Our results highlight pivotal fall-related walking deficits that might be targeted by future rehabilitative interventions that aim at attenuating falls.

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“…As the other perturbation directions are concerned weak and statistically insigni cant relations were found indicating that these outcome measures do not provide information on abilities to appropriately react to unexpected loss of balance during slow walking in the backward, inward and outward directions. Some prospective studies have suggested that the TUG clinical outcome measure may be a good predictor of a potential fall in the stroke population [16,32]. The results of our study have shown that TUG was to some extent related to the abilities of the tested group of post-stroke subjects to react to forward and backward perturbations where the obtained Spearman correlation coe cients were statistically signi cant.…”

Section: Clinical Outcome Measuressupporting

confidence: 63%

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. Methods: Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses (“inside” subgroup) and the other that falls out (“outside” subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. Results: The “inside” subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The “outside” subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the “outside” subgroup compared to the “inside” subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.Conclusions: Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.

show abstract

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

Cited by 87 publications

References 64 publications

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Fall-related functional impairments in patients with neurological gait disorder

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

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