Citation

van Swigchem R, Roerdink M, Weerdesteyn V, Geurts ACH, Daffertshofer A. Phys. Ther. 2014; 94(5): 654-663.

Affiliation

R. van Swigchem, PT, PhD, Department of Rehabilitation (Internal Post Code 898), Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, PO Box 9101, 6500 HB Nijmegen, the Netherlands.

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130108

PMID

24557646

Abstract

BACKGROUND AND OBJECTIVEA reduced capacity to modify gait to the environment may contribute to the fall risk in persons with post-stroke drop foot using an ankle foot orthosis. This study aimed to quantify their capacity to restore steady gait after a step modification.DESIGNThis was a cross-sectional, observational study.METHODSNineteen persons in the chronic phase (>6 months) after stroke (aged 55.0±10.1 years) and 20 persons of similar age (54.6±12.0 years) who were able-bodied were included. Participants were instructed to avoid obstacles that were suddenly released in front of the paretic (stroke group) or left leg (control group) while walking on a treadmill. Outcomes were success rates of obstacle avoidance as well as post-crossing step length, step time, hip flexion angle at foot strike, and peak hip extension of the steps measured within 10 seconds following obstacle release.RESULTSSuccess rates of obstacle avoidance were lower for persons post stroke. Moreover, their first post-crossing step length and time (i.e., the non-paretic step) deviated more from steady gait than those of persons in the control group (i.e., the right step), with lower values for persons post stroke. Similar deviations were observed for post-crossing hip flexion and extension excursions.LIMITATIONPersons post stroke were relatively mildly impaired and used an ankle foot orthosis, which may limit the generalizability to other populations post stroke.CONCLUSIONSPersons with post-stroke drop foot using an ankle foot orthosis have reduced gait adaptability, as evidenced by lower success rates of obstacle avoidance as well as by an impaired capacity to restore steady gait after crossing an obstacle. The latter finding unveils their difficulty in incorporating step modifications in ongoing gait.

Language: en