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Clin Biomech (Bristol, Avon). 2013 Nov-Dec;28(9-10):1041-8. doi: 10.1016/j.clinbiomech.2013.10.010. Epub 2013 Oct 22.

Stepping strategies used by post-stroke individuals to maintain margins of stability during walking.

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1
Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.

Abstract

BACKGROUND:

People recovering from a stroke are less stable during walking compared to able-bodied controls. The purpose of this study was to examine whether and how post-stroke individuals adapt their steady-state gait pattern to maintain or increase their margins of stability during walking, and to examine how these strategies differ from strategies employed by able-bodied people.

METHODS:

Ten post-stroke individuals and 9 age-matched able-bodied individuals walked on the Computer Assisted Rehabilitation Environment. Medio-lateral translations of the walking surface were imposed to manipulate gait stability. To provoke gait adaptations, a gait adaptability task was used, in which subjects occasionally had to hit a virtual target with their knees. We measured medio-lateral and backward margins of stability, and the associated gait parameters walking speed, step length, step frequency, and step width.

FINDINGS:

Post-stroke participants showed similar medio-lateral margins of stability as able-bodied people in all conditions. This was accomplished by a larger step width and a relatively high step frequency. Post-stroke participants walked overall slower and decreased walking speed and step length even further in response to both manipulations compared to able-bodied participants, resulting in a tendency towards an overall smaller backward margins of stability, and a significantly smaller backward margin of stability during the gait adaptability task.

INTERPRETATION:

Post-stroke individuals have more difficulties regulating their walking speed, and the underlying parameters step frequency and step length, compared to able-bodied controls. These quantities are important in regulating the size of the backward margin of stability when walking in complex environments.

KEYWORDS:

Gait; Margins of stability; Step frequency; Step length; Step width; Stroke; Walking speed

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