Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
Tanvi Bhatt, Shamali Dusane, Prakruti Patel
PMID 30902097WHAT IT FOUND
In a lab, people with chronic stroke improved reactive balance after repeated slip-like perturbations, with fewer falls and better stability.
Those with greater leg impairment adapted at lower perturbation intensity, and gains were still present after 3 weeks.
Key findings
01At the pre-training high-intensity slip, 100% of the low-functioning group and 60% of the high-functioning group fell; by the fifth training trial, falls were 9% and 0%.
02Both groups showed improved reactive stability and fewer compensatory steps by the fifth training trial, and the low-functioning group kept improving stability from trial 6 to trial 11 while the high-functioning group did not.
03Immediately after training, fall rates dropped from 60% to 0% in the high-functioning group and from 100% to 27% in the low-functioning group, and stability was similar at post-training and retest.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was not randomized and had no control group, so changes across trials cannot be separated from practice, time, or other effects. It was a single-session laboratory experiment, and the outcomes were lab-induced slip responses, not real-world falls. Twenty six participants, with only 11 in the low-functioning group, limits precision. The low-functioning group and high-functioning group were trained at different perturbation intensities because the low-functioning group could not tolerate the higher intensity, so impairment and intensity are confounded. All participants wore a safety harness, and a fall was partly defined by harness support or researcher assistance, so the measured falls may not represent community falls. The exact lesion size and location were unknown, and the study did not test generalization to other perturbation directions or everyday situations.
Declared interests
The study was funded by the American Heart Association. The provided text does not report author competing interests.
The easy way to misread this
Do not conclude that this perturbation training prevents real-life falls or should be used clinically as an established fall-prevention treatment. The study was a small, non-randomized, single-session laboratory trial without a control group, and it measured lab-induced slip responses, not actual falls outside the lab.