Is lateral external perturbation training more beneficial for protective stepping responses than voluntary stepping training in stroke? A pilot randomized control study.

This was a pilot with only 30 participants randomized and 22 completing training, so the findings are preliminary. The groups were unequal, with 18 in perturbation training and 12 in voluntary training, and 73% had lower motor recovery. The clinical assessor was not blinded to group assignment. Improvements were tested during standing waist-pull and light-cue step tasks, not during walking, stair climbing, or home-based recovery. Neither group improved paretic-leg step characteristics, and the number of paretic lateral steps limited the analysis. Only 5 participants took crossover steps at both sessions, so crossover stepping was not analysed. The perturbation training system was laboratory-based, limiting translation to a home environment. The study did not show that perturbation training was better than voluntary training for clinical balance, because both groups improved.

Funding was from the National Institute on Disability, Independent Living, and Rehabilitation Research, the American Heart Association, and the National Institute on Aging Claude D. Pepper Older Americans Independence Center.

Do not conclude that lateral perturbation training prevents falls or improves paretic-leg stepping. It was a pilot with 30 randomized and 22 completed, showed no paretic-leg step-characteristic changes, and clinical balance improved in both groups.