Body configuration at first stepping-foot contact predicts backward balance recovery capacity in people with chronic stroke.

Autor: de Kam D; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands., Roelofs JMB; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands., Geurts ACH; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.; Sint Maartenskliniek Research, Nijmegen, The Netherlands., Weerdesteyn V; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.; Sint Maartenskliniek Research, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Feb 22; Vol. 13 (2), pp. e0192961. Date of Electronic Publication: 2018 Feb 22 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0192961
Abstrakt: Objective: To determine the predictive value of leg and trunk inclination angles at stepping-foot contact for the capacity to recover from a backward balance perturbation with a single step in people after stroke.
Methods: Twenty-four chronic stroke survivors and 21 healthy controls were included in a cross-sectional study. We studied reactive stepping responses by subjecting participants to multidirectional stance perturbations at different intensities on a translating platform. In this paper we focus on backward perturbations. Participants were instructed to recover from the perturbations with maximally one step. A trial was classified as 'success' if balance was restored according to this instruction. We recorded full-body kinematics and computed: 1) body configuration parameters at first stepping-foot contact (leg and trunk inclination angles) and 2) spatiotemporal step parameters (step onset, step length, step duration and step velocity). We identified predictors of balance recovery capacity using a stepwise logistic regression. Perturbation intensity was also included as a predictor.
Results: The model with spatiotemporal parameters (perturbation intensity, step length and step duration) could correctly classify 85% of the trials as success or fail (Nagelkerke R2 = 0.61). In the body configuration model (Nagelkerke R2 = 0.71), perturbation intensity and leg and trunk angles correctly classified the outcome of 86% of the recovery attempts. The goodness of fit was significantly higher for the body configuration model compared to the model with spatiotemporal variables (p<0.01). Participant group and stepping leg (paretic or non-paretic) did not significantly improve the explained variance of the final body configuration model.
Conclusions: Body configuration at stepping-foot contact is a valid and clinically feasible indicator of backward fall risk in stroke survivors, given its potential to be derived from a single sagittal screenshot.
Databáze: MEDLINE
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