Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

van der Veen, SM, Hammerbeck, U and Hollands, K ORCID: 2020, 'Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults' , Gait & Posture, 81 , pp. 261-267.

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Background: The high prevalence of falls due to trips and slips following stroke may signify difficulty adjusting foot-placement in response to the environment. However, little is known about under what circumstances foot-placement adjustment becomes difficult for stroke survivors (SS), making the design of targeted rehabilitation interventions to improve independent community mobility difficult. Research question: To investigate the effect of planned and reactive target-stepping on foot-placement accuracy in stroke survivors and young and older healthy adults? Methods: Young (N=11, 30±6 years) and older (N=10, 64±8 years) healthy adults and SS (N=11, 67±9 years) walked, at preferred pace, on a force instrumented treadmill. Each participant walked to illuminated targets, visible two steps in advance (planned) or appearing at contralateral midstance (reactive). Foot-placement error (magnitude and bias) and number of missed targets were compared. Results: All participants missed more reactive than planned targets (p=0.05), and SS missed more targets than young (p<0.001) and older (p=0.001) adults. But no interaction showing SS missed more reactive targets than other groups was found. For all groups: reactive adaptations to steps in the anterio-posterior plane resulted in lower error than planned adaptations (p=0.027). Lengthening steps where undershot more than shortening (p<0.001) by all groups. Reactive medio-lateral adaptations over all induced larger error (p=0.029) than planned and changed the direction of bias (p=0.018). Significance: SS experience difficulty making all adjustments, they showed increased error in all conditions but less pronounced difference between planned and reactive stepping. SS may use a reactive control strategy for all adjustments, in contrast to healthy young adults who may plan foot-placement in advance. The likelihood of stroke survivors misplacing a step is large, with 9.8% targets missed; possibly leading to falls. Further investigation is needed to understand foot-placement control strategies used by SS and the role of planning in gait adaptability.

Item Type: Article
Schools: Schools > School of Health Sciences
Journal or Publication Title: Gait & Posture
Publisher: Elsevier
ISSN: 0966-6362
Related URLs:
Depositing User: K Hollands
Date Deposited: 25 Aug 2020 15:09
Last Modified: 16 Feb 2022 05:24

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