Dynamic instability during post-stroke hemiparetic walking
•We directly quantified walking stability in stroke survivors and healthy controls.•Stroke subjects had greater local and orbital instability but remained orbitally stable.•Stroke subjects had greater step width but similar lateral margins of stability (MOS).•Stroke subjects had greater variability...
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| Published in | Gait & posture Vol. 40; no. 3; pp. 457 - 463 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier B.V
01.07.2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0966-6362 1879-2219 1879-2219 |
| DOI | 10.1016/j.gaitpost.2014.05.014 |
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| Abstract | •We directly quantified walking stability in stroke survivors and healthy controls.•Stroke subjects had greater local and orbital instability but remained orbitally stable.•Stroke subjects had greater step width but similar lateral margins of stability (MOS).•Stroke subjects had greater variability in all MOS and step spatiotemporal measures.•Dynamic stability measures detect changes in walking stability associated with stroke.
Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p=0.002) and maxFM (p=0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM<1). In addition, post-stroke individuals walked with greater average step width (p=0.003) but similar average ML MOS (p=0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p<0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls. |
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| AbstractList | Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p = 0.002) and maxFM (p = 0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM < 1). In addition, post-stroke individuals walked with greater average step width (p = 0.003) but similar average ML MOS (p = 0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p < 0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls. •We directly quantified walking stability in stroke survivors and healthy controls.•Stroke subjects had greater local and orbital instability but remained orbitally stable.•Stroke subjects had greater step width but similar lateral margins of stability (MOS).•Stroke subjects had greater variability in all MOS and step spatiotemporal measures.•Dynamic stability measures detect changes in walking stability associated with stroke. Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p=0.002) and maxFM (p=0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM<1). In addition, post-stroke individuals walked with greater average step width (p=0.003) but similar average ML MOS (p=0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p<0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls. Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p = 0.002) and maxFM (p = 0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM < 1). In addition, post-stroke individuals walked with greater average step width (p = 0.003) but similar average ML MOS (p = 0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p < 0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls.Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of walking instability for detecting which individuals will have increased risk of falls. The purposes of this study were to directly quantify walking stability in stroke survivors and neurologically intact controls and to determine which stability measures would reveal the changes in walking stability following stroke. This study thus provided an initial step to establish objective measures for identifying potential fallers. Nine post-stroke individuals and nine controls walked on a treadmill at four different speeds. We computed short-term local divergence exponent (LDE) and maximum Floquet multiplier (maxFM) of the trunk motion, average and variability of dynamic margins of stability (MOS) and step spatiotemporal measures. Post-stroke individuals demonstrated larger short-term LDE (p = 0.002) and maxFM (p = 0.041) in the mediolateral (ML) direction compared to the controls but remained orbitally stable (maxFM < 1). In addition, post-stroke individuals walked with greater average step width (p = 0.003) but similar average ML MOS (p = 0.154) compared to the controls. Post-stroke individuals also exhibited greater variability in all MOS and step measures (all p < 0.005). Our findings indicate that post-stroke individuals walked with greater local and orbital instability and gait variability than neurologically intact controls. The results suggest that short-term LDE of ML trunk motion and the variability of MOS and step spatiotemporal measures detect the changes in walking stability associated with stroke. These stability measures may have the potential for identifying those post-stroke individuals at increased risk of falls. Highlights • We directly quantified walking stability in stroke survivors and healthy controls. • Stroke subjects had greater local and orbital instability but remained orbitally stable. • Stroke subjects had greater step width but similar lateral margins of stability (MOS). • Stroke subjects had greater variability in all MOS and step spatiotemporal measures. • Dynamic stability measures detect changes in walking stability associated with stroke. |
| Author | Dingwell, Jonathan B. Binder-Macleod, Stuart Kao, Pei-Chun Higginson, Jill S. |
| AuthorAffiliation | a Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA b Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA c Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, USA |
| AuthorAffiliation_xml | – name: b Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA – name: a Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA – name: c Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, USA |
| Author_xml | – sequence: 1 givenname: Pei-Chun surname: Kao fullname: Kao, Pei-Chun email: kaop@udel.edu organization: Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA – sequence: 2 givenname: Jonathan B. surname: Dingwell fullname: Dingwell, Jonathan B. organization: Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA – sequence: 3 givenname: Jill S. surname: Higginson fullname: Higginson, Jill S. organization: Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, USA – sequence: 4 givenname: Stuart surname: Binder-Macleod fullname: Binder-Macleod, Stuart organization: Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24931112$$D View this record in MEDLINE/PubMed |
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| Keywords | Stroke Gait Margins of stability Dynamic stability Non-linear dynamics |
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| Snippet | •We directly quantified walking stability in stroke survivors and healthy controls.•Stroke subjects had greater local and orbital instability but remained... Highlights • We directly quantified walking stability in stroke survivors and healthy controls. • Stroke subjects had greater local and orbital instability but... Falls and fall-related injuries cause extremely costly and potentially fatal health problems in people post-stroke. However, there is no global indicator of... |
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| SubjectTerms | Adult Aged Biomechanical Phenomena - physiology Case-Control Studies Dynamic stability Exercise Test Female Gait Gait Disorders, Neurologic - physiopathology Hemiplegia - physiopathology Humans Male Margins of stability Middle Aged Non-linear dynamics Orthopedics Postural Balance - physiology Risk Factors Stroke Stroke - physiopathology Walking - physiology |
| Title | Dynamic instability during post-stroke hemiparetic walking |
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