Journal of Rehabilitation Research & Development (JRRD)

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Volume 52 Number 5, 2015
   Pages 577 — 590

Abstract — Foot placement control and gait instability among people with stroke

Jesse C. Dean, PhD;* Steven A. Kautz, PhD

Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC; and Division of Physical Therapy and Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC

Abstract — Gait instability is a common problem following stroke, as evidenced by increases in fall risk and fear of falling. However, the mechanism underlying gait instability is currently unclear. We recently found that young, healthy humans use a consistent gait stabilization strategy of actively controlling their mediolateral foot placement based on the concurrent mechanical state of the stance limb. In the present work, we tested whether people with stroke (n = 16) and age-matched controls (n = 19) used this neuromechanical strategy. Specifically, we used multiple linear regressions to test whether (1) swing phase gluteus medius (GM) activity was influenced by the simultaneous state of the stance limb and (2) mediolateral foot placement location was influenced by swing phase GM activity and the mechanical state of the swing limb at the start of the step. We found that both age-matched controls and people with stroke classified as having a low fall risk (Dynamic Gait Index [DGI] score >19) essentially used the stabilization strategy previously described in young controls. In contrast, this strategy was disrupted for people with stroke classified as higher fall risk (DGI </=19), particularly for steps taken with the paretic limb. These results suggest that a reduced ability to appropriately control foot placement may contribute to poststroke instability.

Key words: balance, biomechanics, foot placement, frontal plane, kinematics, motor control, muscle activity, stability, stroke, walking.


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This article and any supplementary material should be cited as follows:
Dean JC, Kautz SA. Foot placement control and gait instability among people with stroke. J Rehabil Res Dev. 2015;52(5):577–90.
http://dx.doi.org/10.1682/JRRD.2014.09.0207
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