Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences - Physical Therapy Department

First Advisor

Mary T Blackinton

Publication Date / Copyright Date

2016

Publisher

Nova Southeastern University

Abstract

Problem Statement: Stepping is a common strategy after a perturbation. Stroke survivors display a predilection for stepping with non-paretic leg. Insight into induced stepping between stroke survivors and age-matched control may guide our understanding for reactive postural control training post stroke. Purpose: To investigate the difference in perturbation-induced stepping between chronic stroke survivors and age-matched controls at three phases of the stepping response: preparation, execution, and landing and association with clinical outcome measures. Procedure: Twenty-one community-dwelling chronic stroke survivors (mean age 59y/o ±13yrs) and 17 age- and gender-matched controls (mean age 54.4y/o ±17yrs) completed this study. Clinical measures of gait, balance, range, sensation, and motor control were assessed. A mechanical weight drop of 10% body weight (BW) was used to create the anterior waist pull perturbation during three stance symmetry positions: equal stance (EQ) and two asymmetrical stance (70% BW on dominant leg and 70% BW on nondominant leg). Ten perturbation trials plus two catch trials at 2% BW were given in a standard randomly order at the three stance positions. Kinematic and kinetic data was collected for perturbation steps. Results: The asymmetrical trials resulted in two types of stepping response, steps with the leg bearing 70% BW (loaded steps – LS) and steps with the leg that had 30% BW (unloaded steps – ULS). All subjects initiated steps more often with their unloaded leg (ULS) in the asymmetrical stance trials. In the stroke group the ULS increased paretic leg stepping compared to EQ (p=0.001) and LS (p=0.001). The stroke group had significantly earlier APA onset with both non-paretic leg (p=0.003) and paretic leg (p=0.028), took significantly more steps with paretic (p=0.01) and non-paretic (p=0.07), shorter step length (paretic, p=0.025 and non-paretic p=0.003), and less change in momentum at landing with paretic leg (p=0.01) compared to controls. Conclusion: Reacting to a perturbation is more challenging for chronic stroke survivors than age- and gender-matched control subjects in the preparation, execution, and landing phase of the stepping response regardless of the leg used. Perturbation training should include stepping with both non-paretic and paretic leg.

Disciplines

Physical Therapy

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