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

van der Veen, SM; Hammerbeck, U; Hollands, K

Abstract

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.

Citation

van der Veen, S., Hammerbeck, U., & Hollands, K. (2020). Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults. Gait & Posture, 81, 261-267. https://doi.org/10.1016/j.gaitpost.2020.08.114

• Journal Article Type: Article
• Acceptance Date: Aug 11, 2020
• Online Publication Date: Aug 15, 2020
• Publication Date: Sep 1, 2020
• Deposit Date: Aug 25, 2020
• Publicly Available Date: Aug 15, 2021
• Journal: Gait & Posture
• Print ISSN: 0966-6362
• Electronic ISSN: 1879-2219
• Publisher: Elsevier
• Volume: 81
• Pages: 261-267
• DOI: https://doi.org/10.1016/j.gaitpost.2020.08.114
• Publisher URL: https://doi.org/10.1016/j.gaitpost.2020.08.114
• Related Public URLs: http://www.journals.elsevier.com/gait-and-posture/