TY  - JOUR
PY  - 2020//
TI  - Lateral perturbation-induced and voluntary stepping in fallers and nonfallers after stroke
JO  - Physical therapy
A1  - Gray, Vicki L.
A1  - Fujimoto, Masahiro
A1  - Rogers, Mark W.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0031-9023
UR  - http://dx.doi.org/10.1093/ptj/pzaa109
ID  - ref1
ER  -