Lateral Perturbation-Induced Stepping: Strategies and Predictors in Persons Poststroke.
Vicki L Gray, Chieh-Ling Yang, Sandy McCombe Waller and 1 others
PMID 28922313WHAT IT FOUND
When pushed sideways, people with chronic stroke rarely stepped with their weak leg.
They mostly used their strong leg and took multiple steps. Poor sensation in the weak foot made them avoid using it. This suggests therapy should target stepping with the affected side.
Key findings
01Participants took multiple recovery steps in approximately 70% of trials regardless of perturbation direction, indicating difficulty recovering balance.
02Lateral steps with the paretic leg were used far less frequently (18.8%) when pulled towards that side compared to lateral steps with the non-paretic leg (45.1%) when pulled towards the non-paretic side.
03Hip abductor torque and plantar cutaneous sensation of the paretic foot were key predictors of step type when pulled towards the non-paretic side.
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
Small sample size of 18 participants limits generalizability. Participants were community-dwelling and ambulatory, so results may not apply to those who cannot walk or are institutionalized. The perturbations were expected and applied in a laboratory setting, which differs from unexpected real-world falls. The study was cross-sectional and did not link these stepping strategies directly to prospective fall rates.
Declared interests
No conflicts of interest or funding sources were declared in the provided text.
The easy way to misread this
Do not assume that using the non-paretic leg for stepping is a safe or effective strategy. While it was used more frequently, the high rate of multiple steps indicates that balance recovery was inefficient and potentially unstable, suggesting a need to train paretic limb use rather than reinforce compensation.