Deficits in Motor Response to Avoid Sudden Obstacles During Gait in Functional Walkers Poststroke

I really do believe that if we would be challenged a lot more we would recover much more. It always seemed the therapists were terrified of somehow damaging us and so never did anything remotely close to the edge of our ability.
http://nnr.sagepub.com/content/27/3/230.abstract?etoc

Abstract

Background. Safe community ambulation requires the capacity to adapt gait to environmental changes on short notice. Reduced adaptability may contribute to an increased risk for falls. Objective. This study investigated gait adaptability in community-dwelling persons poststroke and sought to understand some of the mechanisms of reduced adaptability. Methods. Participants were 25 poststroke persons (Functional Ambulation Categories score 5) and 25 healthy controls of similar age. During treadmill walking, 30 obstacles were suddenly dropped in front of the affected leg or left leg of controls. The participants had to avoid the obstacle by either lengthening or shortening the ongoing stride. The obstacle avoidance success rates were determined. Electromyography activity of bilateral biceps femoris, rectus femoris, tibialis anterior, and gastrocnemius medialis muscles was recorded as well as concomitant knee and hip angle courses and spatial characteristics of the avoiding stride. Results. Poststroke persons demonstrated markedly decreased obstacle avoidance success rates, most prominently under time pressure. They showed normal avoidance strategies but had delayed and reduced electromyography responses, smaller joint angle deviations from unperturbed walking, and smaller horizontal margins from the foot to the obstacle. Conclusions. Even in persons who were only mildly affected by stroke, gait adaptability may be reduced, which may place them at risk of falling. Delayed and decreased muscle responses were identified as one possible mechanism with diminished ability to adapt the length of the avoiding stride. Rehabilitation interventions could focus on these impairments.