Abstract
ABSTRACT The purpose of this study was to examine the mechanism of fall risk in community-dwelling ambulatory hemiplegic stroke survivors when exposed to a sudden, trip-like support surface perturbation in standing. Participants (n = 14 / group) included stroke survivors, Age-similar older controls (AC), and Young controls (YC) experienced trip-like perturbation on a motorized treadmill. The primary outcomes were COM state control (measured as COM position (XCOM/BOS) and velocity (VCOM/BOS) relative to the base of support (BOS)) and the vertical limb support recorded as the extent of hip descent. All participants demonstrated forward loss of balance (FLOB) followed by an equal first compensatory step length. At step touchdown, stroke survivors demonstrated lower COM state stability and increased trunk flexion than the YC group. Stroke survivors also demonstrated greater hip descent than YC and AC groups, as they first stepped with their non-paretic limb. For the second compensatory step, the stroke survivors stepped with their paretic limb. However, unlike the AC group, they were unable to control VCOM/BOS despite a longer compensatory step. In conclusion, poor control of COM state, impaired trunk control and inability of the paretic limb to provide vertical limb support may explain the higher fall-risk in stroke survivors.
Highlights
About 3.4 million individuals above 18 years of age are predicted to encounter an episode of stroke by the year 2030 which is a 20.5% increase in prevalence from the year 2012 (Mozaffarian et al 2015)
All participants experienced forward loss of balance (FLOB) and initiated a forward compensatory stepping response resulting in a fall or a recovery (Figure 3(a))
The results of this study demonstrated a reduced reactive control of the center of mass (COM) state (XCOM/base of support (BOS) and VCOM/BOS) in the stroke survivors compared with the age-similar older and younger controls for recovery from triprelated responses
Summary
About 3.4 million individuals above 18 years of age are predicted to encounter an episode of stroke by the year 2030 which is a 20.5% increase in prevalence from the year 2012 (Mozaffarian et al 2015). Community-dwelling ambulatory hemiplegic stroke survivors in the chronic phase continue to exhibit residual sensorimotor impairments such as delayed postural muscle responses (Marigold and Eng 2006), weight-bearing asymmetry and impaired inter-limb coordination (Marigold et al 2004). These may contribute to poor balance control during dynamic balance tasks (Geurts et al 2005) and community ambulation (Keenan et al 1984). Communitydwelling ambulatory hemiplegic stroke survivors are at risk of balance loss while navigating in the community
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