Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke.
Keith E Howard, Nicholas K Reimold, Heather L Knight and 5 others
PMID 38237508WHAT IT FOUND
Better control of how the paretic foot is placed sideways predicted higher balance scores, less fear of falling, and fewer falls in people with chronic stroke.
The link was weak to moderate, so this biomechanical measure does not replace standard clinical assessment.
Key findings
01Modulation of paretic foot placement was the only biomechanical metric significantly related to all four clinical balance measures: Functional Gait Assessment score, Activities-specific Balance Confidence score, fear of falling, and self-reported fall history.
02Individuals who showed a stronger positive relationship between pelvis displacement and foot placement (placing the paretic foot further laterally when the pelvis moved away from the stance foot) had better balance and confidence.
03All significant relationships between the biomechanical metrics and clinical measures were weak to moderate in magnitude.
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 cross-sectional, so it cannot determine if poor foot placement modulation causes balance deficits or if severe stroke deficits lead to both altered gait and poor clinical scores. Participants were required to walk without assistive devices, restricting the findings to a relatively high-functioning subset of people with chronic stroke. Gait was measured on a treadmill, where speeds were substantially lower (median 0.30 m/s) than overground walking (median 0.79 m/s), which may affect the generalizability of the biomechanical patterns. Fall history was self-reported and retrospective, which is prone to recall bias. The analysis did not correct for multiple comparisons, increasing the chance of finding a significant result by chance.
Declared interests
No conflicts of interest were declared.
The easy way to misread this
Do not interpret the significant correlations as evidence that training foot placement modulation will directly improve balance scores or reduce falls. The study is cross-sectional, so it only shows that these factors are linked, not that one causes the other.