Abstract
BackgroundA single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment.MethodsTwenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed.ResultsOn the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control.ConclusionChronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity.
Highlights
More than 800,000 individuals annually suffer from stroke and its associated detrimental long term disability in the USA [1]
This study aimed to examine if people with chronic stroke (PwCS) could acquire reactive adaptation to large slip-like stance perturbations, and if adaptive gains differed based on the perturbation intensity and severity of motor impairment
Trial to trial adaptation Early adaptation All the participants experienced a backward loss of balance after being exposed to level III pre-training perturbation, demonstrating an initial backward compensatory stepping response (22/26) or an aborted step (4/26) followed by multiple stepping, with or without a fall (Fig. 2a)
Summary
More than 800,000 individuals annually suffer from stroke and its associated detrimental long term disability in the USA [1]. The primary deficits associated with stroke, such as sensorimotor impairment, postural dysfunction, and cognitive impairment, result in secondary complications such as falls [2,3,4]. The high risk of falls during the acute phase persists even into the chronic phase when people with chronic stroke (PwCS) regain their ambulatory ability; especially predisposing them to falls from unexpected environmental perturbations such as slips or trips [5]. Reactive balance control plays a crucial role in recovering from large unexpected perturbations, thereby lowering fall-risk [6,7,8,9,10]. A single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment
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