@article{ref1,
title="Lateral perturbation-induced and voluntary stepping in fallers and nonfallers after stroke",
journal="Physical therapy",
year="2020",
author="Gray, Vicki L. and Fujimoto, Masahiro and Rogers, Mark W.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: A loss of balance poststroke from externally induced-perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke.   METHODS: This study used a cohort design. Thirty participants > 6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance-tolerance-limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated.   RESULTS: Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance when compared with nonfallers. There was a between group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation.   CONCLUSION: A high fall rate poststroke necessitates effective fall prevention strategies.Given that more differences were found during perturbation induced stepping between fallers and non-fallers, further research assessing perturbation induced training on reducing falls is needed.   IMPACT: Falls assessments should include both externally induced perturbations, along with voluntary movements in determining the fall risk.<p /> <p>Language: en</p>",
language="en",
issn="0031-9023",
doi="10.1093/ptj/pzaa109",
url="http://dx.doi.org/10.1093/ptj/pzaa109"
}