Walking on uneven terrain in healthy adults and the implications for people after stroke.
Kelly A Hawkins, David J Clark, Chitralakshmi K Balasubramanian and 1 others
PMID 28946584WHAT IT FOUND
Healthy adults walking on uneven terrain change step length, width, timing, body height and muscle co-contraction.
No study directly assessed these adaptations in people after stroke, so terrain difficulty is inferred, not shown.
Key findings
01Healthy adults walking on uneven terrain change step parameters depending on the surface: on foam they take longer, wider steps with longer step time, while on some irregular surfaces they take shorter steps with longer step time.
02To stay stable on uneven terrain, healthy adults lower their center of mass, increase hip and knee flexion, improve toe clearance, use a flatter foot contact, and increase lower-limb muscle activity and co-contraction.
03The paper states that no studies have directly assessed how people after stroke adapt walking to uneven terrain, so its stroke implications are based on known post-stroke gait impairments and performance on other adaptability tasks.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
No studies directly assessed how people after stroke walk on uneven terrain, so the stroke implications are inferred from healthy adult findings and known stroke impairments. The paper does not state how many studies were included, so the breadth of the healthy adult evidence cannot be judged from the text provided. Healthy adult strategies varied by surface and test setup, including differences between overground and treadmill walking, so no single uneven-terrain pattern can be assumed. The paper discusses possible effects of adding uneven terrain to therapy, but it does not test an intervention or report patient outcomes. Some inferences rely on older adults, children with spastic diplegia, or other walking adaptability tasks rather than direct stroke data.
Declared interests
The authors reported no potential conflict of interest, and the paper does not give a funding source.
The easy way to misread this
Do not conclude that uneven-terrain training improves walking after stroke. The review found no studies that directly assessed people after stroke walking on uneven terrain, and it only suggests that such practice may be worth testing.