Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke.

BACKGROUND: Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. RESEARCH QUESTION: Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? METHODS: In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. RESULTS: Only ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SIGNIFICANCE: While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.

Effects of Targeted Assistance and Perturbations on the Relationship Between Pelvis Motion and Step Width in People With Chronic Stroke.

During walking in neurologically-intact controls, larger mediolateral pelvis displacements or velocities away from the stance foot are accompanied by wider steps. This relationship contributes to gait stabilization, as modulating step width based on pelvis motion (hereby termed a "mechanically-appropriate" step width) reduces the risk of lateral losses of balance. The relationship between pelvis displacement and step width is often weakened among people with chronic stroke (PwCS) for steps with the paretic leg. Our objective was to investigate the effects of a single exposure to a novel force-field on the modulation of paretic step width. This modulation was quantified as the partial correlation between paretic step width and pelvis displacement at the step's start (step start paretic [Formula: see text]). Following 3-minutes of normal walking, participants were exposed to 5-minutes of either force-field assistance (n = 10; pushing the swing leg toward mechanically-appropriate step widths) or perturbations (n = 10: pushing the swing leg away from mechanically-appropriate step widths). This period of assistance or perturbations was followed by a 1-minute catch period to identify after-effects, a sign of altered sensorimotor control. The effects of assistance were equivocal, without a significant direct effect or after-effect on step start paretic [Formula: see text]. In contrast, perturbations directly reduced step start paretic [Formula: see text] (p = 0.004), but were followed by a positive after-effect (p = 0.02). These results suggest that PwCS can strengthen the link between pelvis motion and paretic step width if exposed to a novel mechanical environment. Future work is needed to determine whether this effect is extended with repeated perturbation exposure.

Altered active control of step width in response to mediolateral leg perturbations while walking.

During human walking, step width is predicted by mediolateral motion of the pelvis, a relationship that can be attributed to a combination of passive body dynamics and active sensorimotor control. The purpose of the present study was to investigate whether humans modulate the active control of step width in response to a novel mechanical environment. Participants were repeatedly exposed to a force-field that either assisted or perturbed the normal relationship between pelvis motion and step width, separated by washout periods to detect the presence of potential after-effects. As intended, force-field assistance directly strengthened the relationship between pelvis displacement and step width. This relationship remained strengthened with repeated exposure to assistance, and returned to baseline afterward, providing minimal evidence for assistance-driven changes in active control. In contrast, force-field perturbations directly weakened the relationship between pelvis motion and step width. Repeated exposure to perturbations diminished this negative direct effect, and produced larger positive after-effects once the perturbations ceased. These results demonstrate that targeted perturbations can cause humans to adjust the active control that contributes to fluctuations in step width.