Deans' stroke musings: Lateral Perturbation-Induced Stepping: Strategies and Predictors in Persons Poststroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, October 9, 2017

Lateral Perturbation-Induced Stepping: Strategies and Predictors in Persons Poststroke

You should have a fall prevention protocol with lots of perturbations so you can practice preventing falls and know how to land. I had none, now I tend to trip a lot on hidden roots and stumps and the dancing I have to do to stay upright is quite amusing. I'm not always successful at staying upright.
http://journals.lww.com/jnpt/Abstract/2017/10000/Lateral_Perturbation_Induced_Stepping___Strategies.4.aspx

Gray, Vicki L. PhD; Yang, Chieh-ling MS; McCombe Waller, Sandy PhD; Rogers, Mark W. PhD

Journal of Neurologic Physical Therapy: October 2017 - Volume 41 - Issue 4 - p 222–228

doi: 10.1097/NPT.0000000000000202

Research Articles

Background and Purpose: Falls commonly occur as weight is transferred laterally, and impaired reactive stepping responses are associated with falls after stroke. The purpose of this study was to examine differences in and the determinants of mediolateral (M-L) protective stepping strategies when pulled off balance toward the paretic and nonparetic sides.

Methods: Eighteen individuals more than 6 months poststroke were pulled in the M-L direction by a lateral waist-pull perturbation system. Step type (crossover, medial, and lateral) and count were recorded, along with first-step initiation time, length, and clearance. Sensorimotor variables including hip adductor/abductor and ankle plantar flexor/dorsiflexor peak isokinetic torques, paretic foot plantar cutaneous sensation, and motor recovery were used to predict step type by discriminant function analyses (DFAs).

Results: Regardless of pull direction, nearly 70% of trials required 2 or more recovery steps, with more frequent nonparetic leg first steps, 63.5%. The step type was significantly different for pull direction (P = 0.005), with a greater percentage of lateral steps when pulled toward the nonparetic side (45.1%) compared with the paretic side (17.5%). The M-L step length of the lateral step was increased (P < 0.001), with a reduced step clearance (P = 0.05), when pulled toward the paretic side compared with a pull toward the nonparetic side. DFAs revealed that nonparetic and paretic-side pulls could respectively classify step type 64% and 60% of the time, with foot cutaneous sensation discriminating for pull direction.

Discussion and Conclusions: Balance recovery initiated with the nonparetic leg occurred more frequently in response to M-L perturbations, and paretic foot cutaneous sensation was an important predictor of the stepping response regardless of the pull direction.

Video Abstract available for more insights from the authors (see Video, Supplementary Digital Content 1, http://links.lww.com/JNPT/A190).