Jamie Pigman1, Darcy S Reisman2, Ryan T Pohlig3, John J Jeka4, Tamara R Wright5, Benjamin C Conner6, Drew A Petersen7, Michael S Christensen8, Jeremy R Crenshaw9. 1. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; Department of Health and Physical Education, Monmouth University, West, Long Branch, NJ, USA. Electronic address: jpigman@monmouth.edu. 2. Department of Physical Therapy, University of Delaware, Newark, DE, USA. Electronic address: dreisman@udel.edu. 3. Biostatistics Core Facility, University of Delaware, Newark, DE, USA. Electronic address: rpohlig@udel.edu. 4. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA. Electronic address: jjeka@udel.edu. 5. Department of Physical Therapy, University of Delaware, Newark, DE, USA. Electronic address: twright@udel.edu. 6. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA. Electronic address: benjaminconner@email.arizona.edu. 7. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA. Electronic address: dap356@drexel.edu. 8. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA. Electronic address: mschris@udel.edu. 9. Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA. Electronic address: crenshaw@udel.edu.
Abstract
BACKGROUND: To assess the effects of the initial stepping limb on posterior fall recovery in individuals with chronic stroke, as well as to determine the benefits of fall-recovery training on these outcomes. METHODS: This was a single-group intervention study of 13 individuals with chronic stroke. Participants performed up to six training sessions, each including progressively challenging, treadmill-induced perturbations from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. The highest perturbation level achieved, the proportion of successful recoveries, step and trunk kinematics, as well as stance-limb muscle activation about the ankle were compared between the initial stepping limbs in the first session. Limb-specific outcomes were also compared between the first and last training sessions. FINDINGS: In the first session, initial steps with the non-paretic limb were associated with a higher proportion of success and larger perturbations than steps with the paretic limb (p = 0.02, Cohen's d = 0.8). Paretic-limb steps were wider relative to the center of mass (CoM; p = 0.01, d = 1.3), likely due to an initial standing position with the CoM closer to the non-paretic limb (p = 0.01, d = 1.4). In the last training session, participants recovered from a higher proportion of perturbations and advanced to larger perturbations (p < 0.05, d > 0.6). There were no notable changes in kinematic or electromyography variables with training (p > 0.07, d < 0.5). INTERPRETATION: The skill of posterior stepping in response to a perturbation can be improved with practice in those with chronic stroke, we were not able to identify consistent underlying kinematic mechanisms behind this adaptation.
BACKGROUND: To assess the effects of the initial stepping limb on posterior fall recovery in individuals with chronic stroke, as well as to determine the benefits of fall-recovery training on these outcomes. METHODS: This was a single-group intervention study of 13 individuals with chronic stroke. Participants performed up to six training sessions, each including progressively challenging, treadmill-induced perturbations from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. The highest perturbation level achieved, the proportion of successful recoveries, step and trunk kinematics, as well as stance-limb muscle activation about the ankle were compared between the initial stepping limbs in the first session. Limb-specific outcomes were also compared between the first and last training sessions. FINDINGS: In the first session, initial steps with the non-paretic limb were associated with a higher proportion of success and larger perturbations than steps with the paretic limb (p = 0.02, Cohen's d = 0.8). Paretic-limb steps were wider relative to the center of mass (CoM; p = 0.01, d = 1.3), likely due to an initial standing position with the CoM closer to the non-paretic limb (p = 0.01, d = 1.4). In the last training session, participants recovered from a higher proportion of perturbations and advanced to larger perturbations (p < 0.05, d > 0.6). There were no notable changes in kinematic or electromyography variables with training (p > 0.07, d < 0.5). INTERPRETATION: The skill of posterior stepping in response to a perturbation can be improved with practice in those with chronic stroke, we were not able to identify consistent underlying kinematic mechanisms behind this adaptation.
Authors: Avril Mansfield; Elizabeth L Inness; Janice Komar; Louis Biasin; Karen Brunton; Bimal Lakhani; William E McIlroy Journal: Phys Ther Date: 2011-04-21
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Authors: Avril Mansfield; Anthony Aqui; Cynthia J Danells; Svetlana Knorr; Andrew Centen; Vincent G DePaul; Alison Schinkel-Ivy; Dina Brooks; Elizabeth L Inness; George Mochizuki Journal: BMJ Open Date: 2018-08-17 Impact factor: 2.692