Dynamic instability during post-stroke hemiparetic walking

Abstract

Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p=0.002) and maxFM (p=0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM<1). In addition, post-stroke individuals walked with greater average step width (p=0.003) but similar average ML MOS (p=0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p<0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls.