Locomotor circumvention strategies are altered by stroke: II. Postural Coordination.
Anuja Darekar, Anouk Lamontagne, Joyce Fung
PMID 28615080WHAT IT FOUND
Stroke survivors often used side steps, especially for moving obstacles, and showed larger body rotations and, for some obstacles, later reorientation than controls.
Their strategy varied with obstacle movement and their walking speed, balance confidence and motor ability.
Key findings
01Post-stroke participants preferred the side step strategy over the cross step strategy for stationary obstacles, and this preference was stronger for moving obstacles.
02Post-stroke participants showed larger horizontal rotations of the head, thorax, pelvis and left/paretic foot, and greater upper-trunk rolling, than healthy controls.
03For diagonal obstacle approaches, 7/12 stroke participants circumvented to the same side as the obstacle, and this group had lower gait speed, lower motor scores and lower balance confidence than the opposite-side group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only 12 post-stroke participants and 12 healthy controls. Participants with stroke had to walk 30 m independently, score above 27 on the Mini-Mental State Examination, and have no visuospatial neglect or visual field deficits. The task was performed in a virtual room with a helmet display, not in real community environments. Only successful non-collision trials were analysed, so the study did not examine what happens when avoidance fails. The stroke group walked slower and had lower cognitive and balance-confidence scores than controls, so group differences may reflect these baseline differences. No treatment was tested, so the study cannot show that training obstacle circumvention improves safety. Half of the stroke participants used a cane, but the study did not show whether cane use changed the stepping strategy.
Declared interests
The paper states funding was provided by the Institute of Neurosciences, Mental Health and Addiction. It does not report additional conflicts of interest.
The easy way to misread this
Do not conclude that side stepping or larger rotations are safer. The study analysed only successful non-collision trials in a virtual environment and did not test a treatment. Do not apply the results to all people with stroke, because participants had to walk 30 m independently, score above 27 on the Mini-Mental State Examination, and have no visuospatial neglect or visual field deficits.