Anterior fall-recovery training applied to individuals with chronic stroke

Jamie Pigman; Darcy S Reisman; Ryan T Pohlig; John J Jeka; Tamara R Wright; Benjamin C Conner; Drew A Petersen; Jeremy R Crenshaw

doi:10.1016/j.clinbiomech.2019.07.031

Anterior fall-recovery training applied to individuals with chronic stroke

Clin Biomech (Bristol, Avon). 2019 Oct:69:205-214. doi: 10.1016/j.clinbiomech.2019.07.031. Epub 2019 Jul 26.

Authors

Jamie Pigman¹, Darcy S Reisman², Ryan T Pohlig³, John J Jeka⁴, Tamara R Wright⁵, Benjamin C Conner⁶, Drew A Petersen⁷, Jeremy R Crenshaw⁸

Affiliations

¹ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. Electronic address: pigmanj@udel.edu.
² Department of Physical Therapy, University of Delaware, Newark, DE, USA. Electronic address: dreisman@udel.edu.
³ Biostatistics Core Facility, University of Delaware, Newark, DE, USA. Electronic address: rpohlig@udel.edu.
⁴ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. Electronic address: jjeka@udel.edu.
⁵ Department of Physical Therapy, University of Delaware, Newark, DE, USA. Electronic address: twright@udel.edu.
⁶ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA. Electronic address: benjaminconner@email.arizona.edu.
⁷ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA. Electronic address: dap356@drexel.edu.
⁸ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. Electronic address: crenshaw@udel.edu.

Abstract

Background: To study the effects of the initial stepping limb on anterior fall-recovery performance and kinematics, as well as to determine the benefits of fall-recovery training on those outcomes in individuals with chronic stroke.

Methods: Single-group intervention of 15 individuals with chronic stroke who performed up to six sessions of fall-recovery training. Each session consisted of two progressions of treadmill-induced perturbations to induce anterior falls from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. Fall-recovery performance (the highest disturbance level achieved and the proportion of successful recoveries), as well as step and trunk kinematics were compared between the initial stepping limbs on the first session. Limb-specific outcomes were also compared between the first and last training sessions.

Findings: There were no between-limb differences in fall-recovery performance in the first session. With training, participants successfully recovered from a higher proportion of falls (p's = 0.01, Cohen's d's > 0.7) and progressed to larger perturbation magnitudes (p's < 0.06, d's > 0.5). Initial steps with the paretic limb were wider and shorter relative to the center of mass (p's < 0.06, d's > 0.5). With training, initial paretic-limb steps became longer relative to the CoM (p = 0.03, d = 0.7). Trunk forward rotation was reduced when first stepping with the non-paretic limb (p = 0.03, d = 0.6).

Interpretation: The initial stepping limb affects relevant step kinematics during anterior fall recovery. Fall-recovery training improved performance and select kinematic outcomes in individuals with chronic stroke.

Keywords: Balance; Falls; Perturbation training; Postural instability; Rehabilitation; Stroke.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Accidental Falls / prevention & control*
Adult
Aged
Biomechanical Phenomena
Exercise Test
Exercise Therapy / methods*
Extremities
Female
Humans
Male
Middle Aged
Postural Balance*
Stroke / physiopathology*
Stroke Rehabilitation / methods*
Torso
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding