Altered timing of postural reflexes contributes to falling in persons with chronic stroke

Abstract

The purpose of this study was to determine differences in the timing of postural reflexes and changes in kinematics between those who fell (fallers) in response to standing platform translations and those who did not (non-fallers). Forty-four persons with stroke were exposed to unexpected forward and backward platform translations while standing. Surface electromyography from bilateral tibialis anterior, gastrocnemius, rectus femoris, and biceps femoris were recorded along with kinematic data. Those that fell in response to the translations were compared to those who did not fall in terms of (1) postural reflex onset latency, (2) the time interval between the activation of distal and proximal muscles (i.e. intralimb coupling), and (3) changes in joint angles and trunk motion. Approximately 85% of falls occurred in response to the forward translations. Postural reflex onset latencies were delayed and intralimb coupling durations were longer in the faller versus non-faller group. At the time that the platform completed the translating motion (300 ms), the faller group demonstrated higher trunk velocity, greater change in paretic ankle angle, and the trunk was further behind the ankle compared to the non-faller group. This study suggests that following platform translations, delays in the timing of postural reflexes and disturbed intralimb coupling result in changes in kinematics, which contribute to falls in persons with stroke.