Abstract
BackgroundExercise has failed to reduce falls in those with chronic stroke. A limitation of traditional exercise is that the motor responses needed to prevent a fall are not elicited (i.e. they lack processing specificity). Balance reactions often require compensatory steps. Therefore, interventions that target such steps have the potential to reduce falls. Computerized treadmills can deliver precise, repeatable, and challenging perturbations as part of a training protocol. The objective of this study was to develop and determine the feasibility of such training applied to those with chronic stroke. We developed the training to address specificity, appropriate duration and repetition, and progressive overloading and individualization. We hypothesized that our intervention would be acceptable, practical, safe, and demonstrate initial signs of efficacy.MethodsIn this single-arm study, thirteen individuals with chronic stroke (29–77 years old, 2–15 years post stroke) performed up to six training sessions using a computer-controlled treadmill. Each session had separate progressions focused on initial steps with the non-paretic or paretic limbs in response to anterior or posterior falls. Perturbation magnitudes were altered based on performance and tolerance. Acceptability was determined by adherence, or the number of sessions completed. Practicality was documented by the equipment, space, time, and personnel. Adverse events were documented to reflect safety. In order to determine the potential-efficacy of this training, we compared the proportion of successful recoveries and the highest perturbation magnitude achieved on the first and last sessions.ResultsThe training was acceptable, as evident by 12/13 participants completing all 6 sessions. The protocol was practical, requiring one administrator, the treadmill, and a harness. The protocol was safe, as evident by no serious or unanticipated adverse events. The protocol demonstrated promising signs of efficacy. From the first to last sessions, participants had a higher proportion of successful recoveries and progressed to larger disturbances.ConclusionsUsing a computerized treadmill, we developed an approach to fall-recovery training in individuals with chronic stroke that was specific, considered duration and repetition, and incorporated progressive overloading and individualization. We demonstrated that this training was acceptable, practical, safe, and potentially beneficial for high-functioning individuals with chronic stroke.Trial registrationRetrospectively registered at clinicaltrials.gov (NCT03638089) August 20, 2018.
Highlights
Exercise has failed to reduce falls in those with chronic stroke
Despite the beneficial effect that exercise has had on reducing falls in other populations, such as that of community-dwelling older adults [5], exercise has not reduced falls in those with chronic stroke [6, 7]
Their recovery steps are characterized by shorter lengths and more trunk rotation, resulting in a less stable foot placement that is closer to the whole-body center of mass [17, 22]
Summary
Exercise has failed to reduce falls in those with chronic stroke. A limitation of traditional exercise is that the motor responses needed to prevent a fall are not elicited (i.e. they lack processing specificity). Individuals with chronic stroke have an impaired ability to recover from anterior [12,13,14,15] and posterior [16,17,18] falls Those with stroke demonstrate lower anterior and posterior multiple-stepping thresholds, defined as the disturbance magnitude that elicits more than one step, compared to peers with no previous stroke [19]. These lower thresholds are associated with a delayed and reduced muscle response of the paretic limb. Interventions that target fall-recovery steps, including those with the paretic limb, have the potential to reduce falls in individuals with chronic stroke
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