See the published version of this preprint at Journal of NeuroEngineering and Rehabilitation.
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Zlatko Matjacic
University rehabilitation institute, Republic of Slovenia
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9627-218X
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Background : Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects.
Methods : Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses (“inside” subgroup) and the other that falls out (“outside” subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group.
Results : The “inside” subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The “outside” subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead a stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the “outside” subgroup compared to the “inside” subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.
Conclusions : Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Selected clinical outcome measures may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
Keywords
balance assessment, perturbed walking, centre-of-mass, centre-of-pressure, ground-reaction-force
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CURRENT STATUS: Published
View the published article at Journal of NeuroEngineering and Rehabilitation.
No community comments so far
Editorial decision: Accept
On 22 Jun, 2020
Editor assigned
On 18 Jun, 2020
Submission checks complete
On 17 Jun, 2020
Editor invited
On 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 17 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewer #1 agreed
On 26 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Editor assigned
On 19 May, 2020
Submission checks complete
On 18 May, 2020
Editor invited
On 18 May, 2020
Version 2
Posted 14 May, 2020
No comments provided
Review #2 received
Received 15 May, 2020
Editorial decision: Minor revision
On 15 May, 2020
Review #1 received
Received 07 May, 2020
Reviewer #2 agreed
On 04 May, 2020
Editor assigned
On 29 Apr, 2020
Reviewers invited
Invitations sent on 29 Apr, 2020
Reviewer #1 agreed
On 29 Apr, 2020
Submission checks complete
On 28 Apr, 2020
Editor invited
On 28 Apr, 2020
No comments provided
Editorial decision: Major revision
On 20 Apr, 2020
Review #3 received
Received 17 Apr, 2020
Review #2 received
Received 17 Apr, 2020
Review #1 received
Received 05 Apr, 2020
Reviewer #4 agreed
On 30 Mar, 2020
Reviewer #3 agreed
On 29 Mar, 2020
Reviewer #2 agreed
On 24 Mar, 2020
Reviewer #1 agreed
On 27 Feb, 2020
Reviewers invited
Invitations sent on 18 Feb, 2020
Editor assigned
On 13 Feb, 2020
First submitted
On 12 Feb, 2020
Submission checks complete
On 12 Feb, 2020
Editor invited
On 12 Feb, 2020
Metrics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Journal of NeuroEngineering and Rehabilitation.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Zlatko Matjacic
University rehabilitation institute, Republic of Slovenia
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9627-218X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of NeuroEngineering and Rehabilitation.
No community comments so far
Editorial decision: Accept
On 22 Jun, 2020
Editor assigned
On 18 Jun, 2020
Submission checks complete
On 17 Jun, 2020
Editor invited
On 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 17 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewer #1 agreed
On 26 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Editor assigned
On 19 May, 2020
Submission checks complete
On 18 May, 2020
Editor invited
On 18 May, 2020
Version 2
Posted 14 May, 2020
No comments provided
Review #2 received
Received 15 May, 2020
Editorial decision: Minor revision
On 15 May, 2020
Review #1 received
Received 07 May, 2020
Reviewer #2 agreed
On 04 May, 2020
Editor assigned
On 29 Apr, 2020
Reviewers invited
Invitations sent on 29 Apr, 2020
Reviewer #1 agreed
On 29 Apr, 2020
Submission checks complete
On 28 Apr, 2020
Editor invited
On 28 Apr, 2020
No comments provided
Editorial decision: Major revision
On 20 Apr, 2020
Review #3 received
Received 17 Apr, 2020
Review #2 received
Received 17 Apr, 2020
Review #1 received
Received 05 Apr, 2020
Reviewer #4 agreed
On 30 Mar, 2020
Reviewer #3 agreed
On 29 Mar, 2020
Reviewer #2 agreed
On 24 Mar, 2020
Reviewer #1 agreed
On 27 Feb, 2020
Reviewers invited
Invitations sent on 18 Feb, 2020
Editor assigned
On 13 Feb, 2020
First submitted
On 12 Feb, 2020
Submission checks complete
On 12 Feb, 2020
Editor invited
On 12 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of NeuroEngineering and Rehabilitation.
Background : Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects.
Methods : Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses (“inside” subgroup) and the other that falls out (“outside” subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group.
Results : The “inside” subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The “outside” subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead a stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the “outside” subgroup compared to the “inside” subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.
Conclusions : Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Selected clinical outcome measures may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
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