title: Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke.
abstract: Anticipatory postural adjustments, executed prior to gait initiation, help preserve lateral stability when stepping. Atypical patterns of anticipatory activity prior to gait initiation may occur in individuals with unilateral impairment (e.g., stroke). This study aimed to determine the prevalence, correlates, and consequences of atypical anticipatory postural adjustment patterns prior to gait initiation in a sub-acute stroke population. Forty independently-ambulatory individuals with sub-acute stroke stood on two force plates and initiated gait at a self-selected speed. Medio-lateral centre of pressure displacement was calculated and used to define anticipatory postural adjustments (shift in medio-lateral centre of pressure >10mm from baseline). Stroke severity, motor recovery, and functional balance and mobility status were also obtained. Three patterns were identified: single (typical), absent (atypical), and multiple (atypical) anticipatory postural adjustments. Thirty-five percent of trials had atypical anticipatory postural adjustments (absent and multiple). Frequency of absent anticipatory postural adjustments was negatively correlated with walking speed. Multiple anticipatory postural adjustments were more prevalent when leading with the non-paretic than the paretic limb. Trials with multiple anticipatory postural adjustments had longer duration of anticipatory postural adjustment and time to foot-off, and shorter unloading time than trials with single anticipatory postural adjustments. A high prevalence of atypical anticipatory control prior to gait initiation was found in individuals with stroke. Temporal differences were identified with multiple anticipatory postural adjustments, indicating altered gait initiation. These findings provide insight into postural control during gait initiation in individuals with sub-acute stroke, and may inform interventions to improve ambulation in this population.
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
authors.forename: Roshanth
authors.initials: R
authors.lastname: Rajachandrakumar
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Fraser
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Schinkel-Ivy
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Inness
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
authors.forename: Lou
authors.initials: L
authors.lastname: Biasin
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Brunton
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada.
authors.forename: William E
authors.initials: WE
authors.lastname: McIlroy
authors.affiliation: Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada. Electronic address: avril.mansfield@uhn.ca.
authors.forename: Avril
authors.initials: A
authors.lastname: Mansfield
mesh_terms: D000368:Aged; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D004856:Postural Balance; D020521:Stroke / Q000503:physiopathology*; D016138:Walking
keywords: Gait; Gait initiation; Rehabilitation; Stroke