Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects.
Matjaž Zadravec, Andrej Olenšek, Marko Rudolf and 3 others
PMID 32615990WHAT IT FOUND
In slow walking, 44% of stroke subjects fell outside the healthy response range for forward pushes and 27% for backward pushes; outward pushes also showed impaired responses, while inward pushes mostly did not.
Routine tests related only to forward pushes.
Key findings
01For forward and backward perturbations, 44% and 27% of stroke subjects were in the outside subgroup.
02For outward perturbations, the outside subgroup had greater sideways body-sway displacement than the inside subgroup and healthy adults.
03Routine clinical tests showed only moderate relationships with balance responses to forward perturbations starting on the affected leg; relationships for backward, inward, and outward perturbations were weak or insignificant.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only high-functioning independent walkers at the end of inpatient rehabilitation were studied, so the findings do not apply to patients with more severe walking impairment. Not all subjects tolerated pushes at 10% of body weight, and the authors state the findings cannot be generalised. The healthy control group was younger than the stroke group and consisted mainly of institute colleagues, which may have affected the healthy reference range used to classify stroke responses. Some clinical tests were not completed: Four Square Step Test scores were missing for two subjects and Functional Gait Assessment scores were missing for ten patients because of slight dizziness. The authors note that the results depend on the chosen treadmill speed and perturbation strength, so other parameters could change the findings.
Declared interests
The paper lists support from Javna Agencija za Raziskovalno Dejavnost RS.
The easy way to misread this
Do not conclude that routine clinical tests are enough to identify poor reactive balance in all directions. In this study, they were moderately related only to forward perturbations starting on the affected leg, while backward, inward, and outward responses showed weak or insignificant relationships.