title: Responses to gait perturbations in stroke survivors who prospectively experienced falls or no falls.
abstract: Steady-state gait characteristics appear promising as predictors of falls in stroke survivors. However, assessing how stroke survivors respond to actual gait perturbations may result in better fall predictions. We hypothesize that stroke survivors who fall have a diminished ability to adequately adjust gait characteristics after gait is perturbed. This study explored whether gait characteristics of perturbed gait differ between fallers and non fallers.
  
  
  
  Chronic stroke survivors were recruited by clinical therapy practices. Prospective falls were monitored over a six months follow up period. We used the Gait Real-time Analysis Interactive Lab (GRAIL, Motekforce Link B.V., Amsterdam) to assess gait. First we assessed gait characteristics during steady-state gait and second we examined gait responses after six types of gait perturbations. We assessed base of support gait characteristics and margins of stability in the forward and medio-lateral direction.
  
  
  
  Thirty eight stroke survivors complete our gait protocol. Fifteen stroke survivors experienced falls. All six gait perturbations resulted in a significant gait deviation. Forward stability was reduced in the fall group during the second step after a ipsilateral perturbation.
  
  
  
  Although stability was different between groups during a ipsilateral perturbation, it was caused by a secondary strategy to keep up with the belt speed, therefore, contrary to our hypothesis fallers group of stroke survivors have a preserved ability to cope with external gait perturbations as compared to non fallers. Yet, our sample size was limited and thereby, perhaps minor group differences were not revealed in the present study.
authors.affiliation: Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, The Netherlands. Electronic address: Michiel.punt@hu.nl.
authors.forename: Michiel
authors.initials: M
authors.lastname: Punt
authors.affiliation: Move Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China.
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Bruijn
authors.affiliation: Department of Biomechanical Engineering, University of Strathclyde, Glasgow, United Kingdom; Department of Applied Research, Motekforce Link BV, Amsterdam, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Roeles
authors.affiliation: Revant Rehabilitation Center Breda, Breda, The Netherlands.
authors.forename: Ingrid G
authors.initials: IG
authors.lastname: van de Port
authors.affiliation: Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, The Netherlands.
authors.forename: Harriet
authors.initials: H
authors.lastname: Wittink
authors.affiliation: Move Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jaap H
authors.initials: JH
authors.lastname: van Dieën
mesh_terms: D000058:Accidental Falls; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology; D011446:Prospective Studies; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D017741:Survivors
keywords: Falls; Gait; Perturbations; Stability; Stroke