How accuracy of foot-placement is affected by the size of the base of support and crutch support in stroke survivors and healthy adults

Veen, Susanne M. van der; Hammerbeck, Ulrike; Hollands, Kristen

doi:10.1016/j.gaitpost.2019.12.007

Cited by 11 publications

(16 citation statements)

References 35 publications

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“…Our evidence for this 'cluttered terrain strategy' is supported by the fact that SS and OH start 'falling behind the targets in this ongoing target stepping paradigm. This is seen in previous work assessing the effect of support for balance on foot placement accuracy [19]. In previous target stepping literature it has been shown YH participants overshoot shortening and undershoot lengthening targets [19,24].…”

Section: Discussionsupporting

confidence: 59%

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Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

2020

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Background:The high prevalence of falls due to trips and slips following stroke may signify difficulty adjusting foot-placement in response to the environment. However, little is known about under what circumstances footplacement adjustment becomes difficult for stroke survivors (SS), making the design of targeted rehabilitation interventions to improve independent community mobility difficult. Research question:To investigate the effect of planned and reactive target-stepping on foot-placement accuracy in stroke survivors and young and older healthy adults? Methods: Young (N=11, 30±6 years) and older (N=10, 64±8 years) healthy adults and SS (N=11, 67±9 years) walked, at preferred pace, on a force instrumented treadmill. Each participant walked to illuminated targets, visible two steps in advance (planned) or appearing at contralateral midstance (reactive). Foot-placement error (magnitude and bias) and number of missed targets were compared.Results: All participants missed more reactive than planned targets (p=0.05), and SS missed more targets than young (p<0.001) and older (p=0.001) adults. But no interaction showing SS missed more reactive targets than other groups was found. For all groups: reactive adaptations to steps in the anterio-posterior plane resulted in lower error than planned adaptations (p=0.027). Lengthening steps where undershot more than shortening (p<0.001) by all groups. Reactive medio-lateral adaptations over all induced larger error (p=0.029) than planned and changed the direction of bias (p=0.018).Significance: SS experience difficulty making all adjustments, they showed increased error in all conditions but less pronounced difference between planned and reactive stepping. SS may use a reactive control strategy for all adjustments, in contrast to healthy young adults who may plan foot-placement in advance. The likelihood of stroke survivors misplacing a step is large, with 9.8% targets missed; possibly leading to falls. Further investigation is needed to understand foot-placement control strategies used by SS and the role of planning in gait adaptability.

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Section: Discussionsupporting

confidence: 59%

“…We recruited YH (18-40 years old), OH (age matched ±5 years with SS individual) and SS to participate in the study [19]. For SS, inclusion criteria were: >6 months post-stroke, able to walk 10m independently without orthopedic aids or assistance <30s.…”

Section: Participantsmentioning

confidence: 99%

Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

2020

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“…For instance, participants did not actually move through space during treadmill walking as much as they did when they walked over ground. Also, participants were holding onto the handrail and wearing a safety harness only during treadmill walking, which might influence gait performance (van der Veen et al, 2020). Those environmental factors might differentially influence perceptual interactions and peripheral inputs (Alcantara et al, 2018;Simon et al, 2009), which might limit a full transfer from treadmill to overground walking.…”

Section: Discussionmentioning

confidence: 99%

“…Also, a clinical study in individuals post-stroke indicated that variable practice was beneficial to the improvement in functional gains (Hornby et al, 2019). However, other studies in individuals post-stroke showed that variable walking practice (e.g., walking at variable speed) had modest impact on motor learning (Helm et al, 2019;Rendos et al, 2020) and was not superior to conventional treadmill walking (DePaul et al, 2015), and larger errors actually prevented transfer (Torres-Oviedo & Bastian, 2012). However, it remains unclear whether increasing motor variability will facilitate motor learning in weight shift toward the paretic side during walking in individuals post-stroke.…”

Section: Introductionmentioning

confidence: 99%

Increased motor variability facilitates motor learning in weight shift toward the paretic side during walking in individuals post‐stroke

Park

Hsu

Lin

et al. 2021

Eur J of Neuroscience

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The purpose of this study was to determine whether applying "varied" versus constant pelvis assistance force mediolaterally toward the paretic side of stroke survivors during walking would result in short-term improvement in weight shift toward the paretic side. Twelve individuals post-stroke (60.4 ± 6.2 years; gait speed: 0.53 ± 0.19 m/s) were tested under two conditions (varied vs. constant). Each condition was conducted in a single separate session, which consisted of (a) treadmill walking with no assistance force for 1 min (baseline), pelvis assistance toward the paretic side for 9 min (adaptation), and then no force for additional 1 min (postadaptation), and (b) overground walking. In the "varied" condition, the magnitude of force was randomly changed across steps between 30% and 100% of the predetermined amount. In the abrupt condition, the magnitude of force was kept constant at 100% of the predetermined amount. Participants exhibited greater improvements in weight shift toward the paretic side (p < 0.01) and in muscle activity of plantar flexors and hip adductors of the paretic leg (p = 0.02) from baseline to late postadaptation period for the varied condition than for the constant condition. Motor variability of the peak pelvis displacement at baseline was correlated with improvement in weight shift toward the paretic side after training for the varied (R 2 = 0.64, p = 0.01) and the constant condition (R 2 = 0.39, p = 0.03). These findings suggest that increased motor variability, induced by applying the varied pelvis assistance, may facilitate motor learning in weight shift and gait symmetry during walking in individuals post-stroke.

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“…Older adults were found to be particularly poor at making corrections for sideways stepping-target shifts when walking (Hoogkamer et al 2015;Mazaheri et al 2015). Another task in which older adults have been found to have later responses (and a lower accuracy) when adjusting their trajectory is when stepping from quiet stance (gait initiation) (Sun et al 2017;Tseng et al 2009). During obstacle avoidance in walking, it was observed that muscle activation took about 10 ms longer in older adults than in young adults (Weerdesteyn et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Effects of ageing on responses to stepping-target displacements during walking

et al. 2020

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Purpose Human sensory and motor systems deteriorate with age. When walking, older adults may therefore find it more difficult to adjust their steps to new visual information, especially considering that such adjustments require control of balance as well as of foot trajectory. Our study investigates the effects of ageing on lower limb responses to unpredictable target shifts. Methods Participants walked on a treadmill with projected stepping targets that occasionally shifted in the medial or lateral direction. The shifts occurred at a random moment during the early half of the swing phase of either leg. Kinematic, kinetic and muscle activity data were collected. Results Older adults responded later and corrected for a smaller proportion of the shift than young adults. The order in which muscle activation changed was similar in both groups, with responses of gluteus medius and semitendinosus from about 120 to 140 ms after the shift. Most muscles responded slightly later to lateral target shifts in the older adults than in the young adults, but this difference was not observed for medial target shifts. Ageing delayed the behavioural responses more than it did the electromyographic (EMG) responses. Conclusions Our study suggests that older adults can adjust their walking to small target shifts during the swing phase, but not as well as young adults. Furthermore, muscle strength probably plays a substantial role in the changes in online adjustments during ageing.

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How accuracy of foot-placement is affected by the size of the base of support and crutch support in stroke survivors and healthy adults

Cited by 11 publications

References 35 publications

Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

Increased motor variability facilitates motor learning in weight shift toward the paretic side during walking in individuals post‐stroke

Effects of ageing on responses to stepping-target displacements during walking

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