Abstract
Falls risk increases with ageing but is substantially higher in people with stroke. Tripping-related balance loss is the primary cause of falls, and Minimum Toe Clearance (MTC) during walking is closely linked to tripping risk. The aim of this study was to determine whether real-time augmented information of toe-ground clearance at MTC can increase toe clearance, and reduce tripping risk. Nine healthy older adults (76 ± 9 years) and one 71 year old female stroke patient participated. Vertical toe displacement was displayed in real-time such that participants could adjust their toe clearance during treadmill walking. Participants undertook a session of unconstrained walking (no-feedback baseline) and, in a subsequent Feedback condition, were asked to modify their swing phase trajectory to match a “target” increased MTC. Tripping probability (PT) pre- and post-training was calculated by modeling MTC distributions. Older adults showed significantly higher mean MTC for the post-training retention session (27.7 ± 3.79 mm) compared to the normal walking trial (14.1 ± 8.3 mm). The PT on a 1 cm obstacle for the older adults reduced from 1 in 578 strides to 1 in 105,988 strides. With gait training the stroke patient increased MTC and reduced variability (baseline 16 ± 12 mm, post-training 24 ± 8 mm) which reduced obstacle contact probability from 1 in 3 strides in baseline to 1 in 161 strides post-training. The findings confirm that concurrent visual feedback of a lower limb kinematic gait parameter is effective in changing foot trajectory control and reducing tripping probability in older adults. There is potential for further investigation of augmented feedback training across a range of gait-impaired populations, such as stroke.
Highlights
The World Health Organization reports that falls injuries are the second leading cause of unintentional death after road accidents and are the major precursor to death in the elderly (WHO, 2002)
Goldie et al (2000) found that in the homes of 22 stroke patients recently discharged from hospital, 2.5 to 4.4 obstacles were encountered for every 10 m of ambulation
ANOVA results indicated that for the older participants none of the walking cycle variables in Table 1 changed significantly from baseline to retention. In interpreting these results it is, worthwhile to note that these variables are influenced by walking velocity which was held constant across the two conditions (Older Group = 0.72 m/s; stroke patient = 0.28 m/s)
Summary
The World Health Organization reports that falls injuries are the second leading cause of unintentional death after road accidents and are the major precursor to death in the elderly (WHO, 2002). It is estimated that approximately 73% of stroke patients fall at least once in the first 6-months following discharge from inpatient rehabilitation (Forster and Young, 1995). The primary cause of falls-related injury is tripping (Cohen et al, 2003) due to unanticipated foot contact with ground-based objects, sufficient to irretrievably destabilize the individual (Nagano et al, 2011). Obstacles have been directly implicated in 10% of falls following stroke (Forster and Young, 1995). Foot trajectory during the swing phase of the gait cycle must maintain progression in the direction of travel, reflected in step length, and incorporate a vertical displacement component sufficient to accommodate changes in support surface elevation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
