Abstract
This study aims to compare the differences in the kinematic characteristics of crossing obstacles of different heights between stroke survivors and age-matched healthy controls and to identify the changes of balance control strategy and risk of falling. Twelve stroke survivors and twelve aged-matched healthy controls were recruited. A three-dimensional motion analysis system and two force plates were used to measure the kinematic and kinetic data during crossing obstacles with heights of 10, 20, and 30% leg length. The results showed that during leading and trailing limb clearance, (AP) center of mass (COM) velocities of the stroke group were smaller than those of the healthy controls for all heights. The decreased distances between COM and center of pressure (COP) in the AP direction during the both trailing and leading limb support period were also found between stroke survivors and healthy controls for all heights. The COM velocity and COM-COP distance significantly correlated with the lower limb muscle strength. In addition, stroke survivors showed greater lateral pelvic tilt, greater hip abduction, and larger peak velocity in the medio-lateral (ML) direction. There was a positive correlation between the COM-COP distance in the AP direction and the clinical scales. These results might identify that the stroke survivors used a conservative strategy to negotiate the obstacles and control balance due to a lack of muscle strength. However, the abnormal patterns during obstacle crossing might increase the risk of falling. The findings could be used to design specific rehabilitation training programs to enhance body stability, reduce energy cost, and improve motion efficiency.
Highlights
IntroductionMost community-dwelling stroke survivors can walk safely on level surfaces, but they have difficulties in maintaining balance during complex motor tasks such as obstacle crossing [1]
The impairments from stroke impact patients’ activities in daily life
During the leading and trailing limb clearance, the anteriorposterior center of mass (AP COM) velocity of the stroke group was smaller than that of the healthy controls for all obstacle heights (p < 0.05, Figures 3A,B), and it decreased with the increasing obstacle height at leading limb clearance (p < 0.05, Figure 3A)
Summary
Most community-dwelling stroke survivors can walk safely on level surfaces, but they have difficulties in maintaining balance during complex motor tasks such as obstacle crossing [1]. Stroke survivors are more likely to fall during obstacle avoidance, either by contacting the obstacle or losing balance [2]. The consequences of falling include hip fractures, soft tissue injuries, fear of Obstacle Crossing of Stroke Survivors falling, hospitalization, increased immobility, and greater disability [3, 4]. Said and colleagues found stroke survivors who failed in the obstacle crossing task demonstrated higher falling risk compared with who passed the task [5]. Identifying falling risk during obstacle crossing and preventing falls are important for stroke survivors [6]
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