How accuracy of foot-placement is affected by the size of the base of support and crutch support in stroke survivors and healthy adults

Research output: Contribution to journalArticlepeer-review

Abstract

Background
The high prevalence of falls due to trips and slips following stroke may signify difficulty controlling balance and adjusting foot-placement in response to the environment. We know very little about how controlling foot-placement is affected by balance requirements and the effects of stroke. Therefore, in this study the research question is how foot-placement control is affected by balance support from crutches and reducing or enlarging the base of support. By understanding how foot-placement control and balance deficits following stroke interact, rehabilitation efforts can be more effectively targeted towards the cause of poor mobility.

Methods
Young (N=13, 30±6 years) and older (N=10, 64±8 years) healthy adults and stroke survivors (N=11, 67±9 years) walked to targets on an instrumented treadmill with or without crutch support for balance. Targets were randomized to either reduce or increase the base of support in the antero-posterior (AP) or medio-lateral (ML) direction. Mean and absolute foot-placement error were measured using motion analysis. These outcomes were compared using repeated measures ANCOVA with walking speed as a covariate.

Results
Overall, stroke survivors missed more targets (9.1±2.3%, p=0.001) than young (1.0±2.5%) and older (0.2±2.1%) healthy adults (p=0.001). However, there were no significant differences between groups in foot-placement error. Crutch support reduced both AP and ML foot-placement error (p=
Significance
Stroke survivors have greater difficulty accurately adjusting steps in response to the environment. Crutch support reduces foot-placement error for all steps, but particularly when narrowing foot-placement. These results provide support for the implication of walking aids, which support balance to improve ability to adjust footplacement in response to the environment.
Original languageEnglish
Pages (from-to)224-230
Number of pages6
JournalGait & Posture
Volume76
DOIs
Publication statusPublished - 19 Dec 2019

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