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.

Friday, January 24, 2025

Plantar sensation associates with gait instability in older adults

 Will your competent? doctor create a protocol to test for this and another one to provide a solution to restore plantar sensation? NO? So. you DON'T have a functioning stroke doctor, do you?

Plantar sensation associates with gait instability in older adults

Abstract

Background

Advanced age brings a loss of plantar sensation, represented, for example, as higher sensation thresholds in standardized testing. This is thought to contribute to an increased risk of falls among older adults – an intuitive premise that has yet to be fully investigated, especially in the context of walking balance. The purpose of this study was to quantify the association between plantar sensation and the instability elicited by a suite of walking balance perturbations that differ in direction and context in a cohort of n = 28 older adults (73.0 ± 5.9 yrs).

Methods

We measured plantar sensation using Semmes-Weinstein monofilaments and quantified margins of stability (MoS) and whole-body angular momentum (WBAM) during habitual walking and in response to optical flow perturbations, lateral waist-pull perturbations, and treadmill-induced slips.

Results

Our two major results were that higher monofilament thresholds (i.e., worse plantar sensation) in older adults associated with: (1) larger anterior-posterior (AP) and mediolateral (ML) MoS and increased transverse plane WBAM (p ≤ 0.031) during habitual walking, and (2) larger decreases in MoSAP, MoSML and larger increases in transverse plane WBAM in response to lateral waist pull perturbations (p ≤ 0.018). We found no associations between plantar sensation and responses to other perturbation contexts.

Conclusions

We conclude that there is an association between worse plantar sensation and gait instability, both during habitual unperturbed walking and in response to some perturbation contexts. These results should build confidence that interventions designed to improve plantar sensation for older adults, possibly through insoles or footwear modifications, could be critical for reducing gait-related falls in at-risk populations.

Introduction

Maintaining stability during walking requires a combination of vestibular, somatosensory, and visual feedback. Plantar somatosensation (which we refer to as “plantar sensation” from here on) provides critical afferent feedback to the body presumed necessary to regulate balance [1]. Advanced age brings a loss of plantar sensation, represented, for example, as higher sensation thresholds in standardized testing [2, 3]. This is intuitively thought to contribute to an increased risk of falls among older adults. Past research has hinted at this increased risk, using unperturbed standing or standing perturbation responses as proxies for increased fall risk or inducing loss of plantar sensation through anesthesia or hypothermia in younger adults [1, 4, 5]. However, no study to date has established an empirical relation between plantar sensation and vulnerability to perturbations applied during walking. This is important because walking is the task in which most falls occur among older adults [6]. This study is designed to address this clinically important gap in our understanding.

Preserving walking balance requires the deployment of neuromuscular corrections to a broad variety of challenges in the real-world. Balance perturbations are laboratory-based paradigms often used to emulate the instability elicited by these diverse balance challenges. These perturbations can take many forms, including surface translations [7], lateral pulls [8], sensory manipulations [9, 10], etc. We recently revealed that, despite some generalizations, the instability elicited by walking balance perturbations differs based on their context in both younger and older adults [11]. This implies that any study seeking to understand the association between a potentially modifiable factor – in our case, plantar sensation – and the gait instability elicited by balance perturbations would be encouraged to account for differences in the context of that instability. One way to account for those differences is to use of a suite of balance perturbations that emulates the diverse challenges capable of precipitating a fall in the real world.

Following the onset of a balance disturbance, somatosensory feedback is required to initiate a neuromuscular cascade that results in a balance correction to mitigate instability and prevent falls. As one primary example, compression of plantar cutaneous mechanoreceptors has the potential to provide rapid afferent signaling for balance corrections. The Semmes-Weinstein monofilament (SWM) test is a clinically-validated measure designed to quantify thresholds for plantar sensation [12,13,14]. Decreases in the integrity of that signaling pathway, for example via intradermal anesthetic solution injections to the plantar foot surface in younger adults, compromises recovery from unanticipated surface translations during standing [5]. These experimental findings bolster intuition regarding the effect of age-related declines in plantar sensation and those in balance integrity more broadly. Indeed, older adults have been reported to exhibit increased plantar sensation thresholds determined via the SWM test [2, 3]. Quantifying the extent to which those declines in planar sensation among older adults associate with an increased vulnerability to walking balance perturbations could build confidence in potentially modifiable factors to mitigate gait instability and therapeutic interventions to improve walking balance.

Thus, the purpose of this study was to address this gap and quantify the association between plantar sensation and the instability elicited by a suite of walking balance perturbations that differ in direction and context in a cohort of older adult participants. We tested the hypothesis that older adults with lesser plantar sensation, evidenced by higher average thresholds on a monofilament test, would also exhibit higher gait instability and vulnerability to walking balance perturbations.

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