How accuracy of foot-placement is affected by the size of the base of support and crutch support 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 controlling balance and adjusting foot-placement in response to the environment. We know very little about how controlling foot-placement is affected by balance requirements and the effects of stroke. Therefore, in this study the research question is how foot-placement control is affected by balance support from crutches and reducing or enlarging the base of support. By understanding how foot-placement control and balance deficits following stroke interact, rehabilitation efforts can be more effectively targeted towards the cause of poor mobility.

Methods
Young (N=13, 30±6 years) and older (N=10, 64±8 years) healthy adults and stroke survivors (N=11, 67±9 years) walked to targets on an instrumented treadmill with or without crutch support for balance. Targets were randomized to either reduce or increase the base of support in the antero-posterior (AP) or medio-lateral (ML) direction. Mean and absolute foot-placement error were measured using motion analysis. These outcomes were compared using repeated measures ANCOVA with walking speed as a covariate.

Results
Overall, stroke survivors missed more targets (9.1±2.3%, p=0.001) than young (1.0±2.5%) and older (0.2±2.1%) healthy adults (p=0.001). However, there were no significant differences between groups in foot-placement error. Crutch support reduced both AP and ML foot-placement error (p=<0.001, AP 5.2±0.5cm unsupported, 4.1±0.4cm supported, ML 2.3±0.2cm unsupported, 1.9±0.2cm supported) for all participants. Interaction effects indicate crutch support reduced foot-placement error more when narrowing (unsupported 2.8±0.2cm, supported 1.8±0.2cm) than widening (unsupported 2.6±0.4cm, supported 2.4±0.4cm) steps (p<0.001),

Significance
Stroke survivors have greater difficulty accurately adjusting steps in response to the environment. Crutch support reduces foot-placement error for all steps, but particularly when narrowing foot-placement. These results provide support for the implication of walking aids, which support balance to improve ability to adjust footplacement in response to the environment.

Citation

van der Veen, S., Hammerbeck, U., & Hollands, K. (2020). How accuracy of foot-placement is affected by the size of the base of support and crutch support in stroke survivors and healthy adults. Gait & Posture, 76, 224-230. https://doi.org/10.1016/j.gaitpost.2019.12.007

• Journal Article Type: Article
• Acceptance Date: Dec 6, 2019
• Online Publication Date: Dec 19, 2019
• Publication Date: Feb 1, 2020
• Deposit Date: Jan 23, 2020
• Publicly Available Date: Dec 19, 2020
• Journal: Gait & Posture
• Print ISSN: 0966-6362
• Electronic ISSN: 1879-2219
• Publisher: Elsevier
• Volume: 76
• Pages: 224-230
• DOI: https://doi.org/10.1016/j.gaitpost.2019.12.007
• Publisher URL: https://doi.org/10.1016/j.gaitpost.2019.12.007
• Related Public URLs: https://www.sciencedirect.com/journal/gait-and-posture