Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors.

Hanatsu Nagano,Lisa James,Rezaul Begg,Catherine M Said,William A Sparrow

doi:10.3389/fphys.2022.833417

Abstract

Increased falls risk is prevalent among stroke survivors with gait impairments. Tripping is the leading cause of falls and it is highly associated with mid-swing Minimum Foot Clearance (MFC), when the foot’s vertical margin from the walking surface is minimal. The current study investigated MFC characteristics of post-stroke individuals (n = 40) and healthy senior controls (n = 21) during preferred speed treadmill walking, using an Optotrak 3D motion capture system to record foot-ground clearance. In addition to MFC, bi-lateral spatio-temporal gait parameters, including step length, step width and double support time, were obtained for the post-stroke group’s Unaffected and Affected limb and the control group’s Dominant and Non-dominant limbs. Statistical analysis of MFC included central tendency (mean, median), step-to-step variability (standard deviation and interquartile range) and distribution (skewness and kurtosis). In addition, the first percentile, that is the lowest 1% of MFC values (MFC 1%) were computed to identify very high-risk foot trajectory control. Spatio-temporal parameters were described using the mean and standard deviation with a 2 × 2 (Group × Limb) Multivariate Analysis of Variance applied to determine significant Group and Limb effects. Pearson’s correlations were used to reveal any interdependence between gait variables and MFC control. The main finding of the current research was that post-stroke group’s affected limb demonstrated lower MFC 1% with higher variability and lower kurtosis. Post-stroke gait was also characterised by shorter step length, larger step width and increased double support time. Gait retraining methods, such as using real-time biofeedback, would, therefore, be recommended for post-stroke individuals, allowing them to acquire optimum swing foot control and reduce their tripping risk by elevating the swing foot and improving step-to-step consistency in gait control.

Highlights

IntroductionAcross a range of conditions gait impairments commonly present as walking with shorter, wider steps, increased variability in step length and timing (Wang et al, 2019) and prolonged double support, when both feet are in contact with the ground (Hollman et al, 2011; Taniguchi et al, 2019)
A stroke is one of the most common and serious ageing-related health risks, with over 100 incidents documented in Australia every day (Australian Institute of Health and Welfare, 2020)
A Group x Limb interaction was obtained for kurtosis (F1, 118 = 3.981, p = 0.048) with stroke individuals (Stroke)’s affected limb showing lower Minimum Foot Clearance (MFC) kurtosis (0.211) compared to their unaffected side (0.727) and the Control dominant (0.537) and non-dominant limb (1.418)

Summary

Introduction

Across a range of conditions gait impairments commonly present as walking with shorter, wider steps, increased variability in step length and timing (Wang et al, 2019) and prolonged double support, when both feet are in contact with the ground (Hollman et al, 2011; Taniguchi et al, 2019) These gait characteristics are all typical of post-stroke individuals (Balasubramanian et al, 2009; Osada et al, 2021). Gait impairments can be viewed as reflecting clinically defined sensorimotor deficits (Callisaya et al, 2010; Taylor et al, 2012) but they emerge as cautious gait adaptations to secure stability in response to a greater fear of falling (Young and Dingwell, 2012; Tsai and Lin, 2013; Bueno et al, 2019) It is, expected that in post-stroke individuals disrupted sensorimotor functions physically disturb healthy, vigorous walking (Jones and Adkins, 2015). As to why post-stroke individuals have such a high risk of falling when they do appear to employ cautious gait adaptations in an attempt to ensure their safety

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Conclusion