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Modulation of reactive response to slip-like perturbations: effect of explicit cues on paretic versus non-paretic side stepping and fall-risk

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Abstract

This study aimed to examine the effect of explicit cuing on reactive stepping with the paretic limb during slip-like perturbations in stroke survivors and to identify differences in postural stability and fall-risk while stepping with either limb. Eleven chronic hemiparetic stroke survivors received slip-like stance perturbations in no-cue (implicit, no instructions) and cued (explicit, instructions to step with paretic limb) conditions. Frequency of stepping with the paretic limb was recorded. Differences between non-paretic and paretic steps for falls, number of compensatory steps, relative center-of-mass position (X COM/BOS), and velocity \((\dot{X}_{\rm COM/BOS} )\), and vertical limb support (hip descent—Z hip) were analyzed. Stepping with the paretic limb increased from 6 % in no-cue condition to 42 % in cued condition with no significant difference in number of falls and steps regardless of stepping limb. At liftoff of the compensatory step, stability was greater (anterior X COM/BOS) with paretic than non-paretic limb stepping whereas, at touchdown (TD) of the step, stability with paretic limb reduced (posterior X COM/BOS and \(\dot{X}_{\rm COM/BOS}\)) due to a smaller compensatory step taken with the paretic versus non-paretic limb. There was no significant difference in peak Z hip regardless of stepping limb; however, the timing of peak Z hip differed (occuring prior to TD during non-paretic stepping and post-TD during paretic stepping). Thus, fall onset was earlier with non-paretic versus paretic stepping. The results support that explicit cueing can facilitate initiation of reactive step from the paretic limb as compared with the no-cue condition. Stepping with the paretic limb in the cued condition however altered time of fall onset. Regardless of the stepping side, individuals demonstrated a fall risk suggesting the need for interventions focusing on reactive step training with both the limbs.

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Abbreviations

BOS:

Base of support

COM:

Center of mass

LO:

Liftoff

TD:

Touchdown

X COM/BOS :

Center-of-mass position relative to the base of support

\(\dot{X}_{\rm COM/BOS}\) :

Center-of-mass velocity relative to heel velocity of the limb forming the posterior margin of base of support

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Acknowledgments

This study was supported by the American Heart Association, National Affiliate for the Scientific Development Grant 12SDG12170022. Findings from this study were presented at the Society of Neuroscience Conference 2014, Washington, DC. We would like to thank Vandana Vaid, Abdul Karim, and Pooja Salot for assistance with data collection and processing.

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  1. Department of Physical Therapy, University of Illinois at Chicago, 514-E, 1919 W. Taylor Street, 4th Floor, Chicago, IL, 60612, USA

    Prakruti Patel & Tanvi Bhatt

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  1. Prakruti Patel
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Correspondence to Tanvi Bhatt.

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Patel, P., Bhatt, T. Modulation of reactive response to slip-like perturbations: effect of explicit cues on paretic versus non-paretic side stepping and fall-risk. Exp Brain Res 233, 3047–3058 (2015). https://doi.org/10.1007/s00221-015-4367-9

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  • DOI: https://doi.org/10.1007/s00221-015-4367-9

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