Rajachandrakumar R, Fraser JE, Schinkel-Ivy A, Inness EL,
Biasin L, Brunton K, McIlroy WE, Mansfield A
Gait Posture. 2016 Dec 21;52:325-331
Anticipatory postural adjustments, executed prior to gait
initiation, help preserve lateral stability when stepping. Atypical patterns of
anticipatory activity prior to gait initiation may occur in individuals with
unilateral impairment (e.g., stroke). This study aimed to determine the
prevalence, correlates, and consequences of atypical anticipatory postural
adjustment patterns prior to gait initiation in a sub-acute stroke population.
Forty independently-ambulatory individuals with sub-acute stroke stood on two
force plates and initiated gait at a self-selected speed. Medio-lateral centre
of pressure displacement was calculated and used to define anticipatory
postural adjustments (shift in medio-lateral centre of pressure >10mm from
baseline). Stroke severity, motor recovery, and functional balance and mobility
status were also obtained. Three patterns were identified: single (typical),
absent (atypical), and multiple (atypical) anticipatory postural adjustments.
Thirty-five percent of trials had atypical anticipatory postural adjustments
(absent and multiple). Frequency of absent anticipatory postural adjustments
was negatively correlated with walking speed. Multiple anticipatory postural
adjustments were more prevalent when leading with the non-paretic than the
paretic limb. Trials with multiple anticipatory postural adjustments had longer
duration of anticipatory postural adjustment and time to foot-off, and shorter
unloading time than trials with single anticipatory postural adjustments. A
high prevalence of atypical anticipatory control prior to gait initiation was
found in individuals with stroke. Temporal differences were identified with
multiple anticipatory postural adjustments, indicating altered gait initiation.
These findings provide insight into postural control during gait initiation in
individuals with sub-acute stroke, and may inform interventions to improve
ambulation in this population.
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