Citation

Inness EL, Mansfield A, Lakhani B, Bayley M, McIlroy WE. Phys. Ther. 2014; 94(12): 1755-1764.

Affiliation

W.E. McIlroy, PhD, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; Toronto Rehabilitation Institute-University Health Network; Graduate Department of Rehabilitation Science, University of Toronto; Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery; and the Brain Sciences Program, Sunnybrook Health Sciences Centre.

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130603

PMID

25104795

Abstract

BACKGROUND & PURPOSE: Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls. The purpose of the study was to: determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly-used clinical measures of balance, mobility and lower limb impairment.

METHODS: A retrospective chart review of patients with stroke who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment.

RESULTS: Ninety nine of 139 (71%) patients had impaired stepping reactions characterized by: the need for assistance, an inability to step with either lower limb, or the need for multiple step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17-1.43 versus 0.26 to 1.55 m/sec for patients who demonstrated a failed step versus a successful step, respectively.

CONCLUSIONS: Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge which could possibly increase their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls & to direct appropriate intervention strategies.

Language: en