Impaired Reactive Stepping Among Patients Ready for Discharge From Inpatient Stroke Rehabilitation

Some decade our therapists will come up with a standard walking and fall prevention protocol. I know I never received any perturbation training unless putting me in a Balance Trainer one time counts. And I would never consider that as valid since the harness was always there to catch me.
Harnesses don't help because they catch you too soon, you don't get a chance to save yourself before the fall.
http://ptjournal.apta.org/content/early/2014/08/06/ptj.20130603.abstract 

1. Elizabeth L. Inness (liz.inness@uhn.ca),
2. Avril Mansfield,
3. Bimal Lakhani,
4. Mark Bayley and
5. William E. McIlroy

+ Author Affiliations

1. E.L.Inness, BScPT, MSc, PhD candidate, Toronto Rehabilitation Institute–University Health Network, 550 University Ave, Toronto, Ontario, Canada, M5G 2A2, and Department of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, Ontario, Canada.
2. A. Mansfield, PhD, Toronto Rehabilitation Institute–University Health Network; Department of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto; the Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery; and the Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
3. B. Lakhani, PhD, Toronto Rehabilitation Institute–University Health Network (currently affiliated with the University of British Columbia, Vancouver, British Columbia, Canada).
4. M. Bayley, MD, Toronto Rehabilitation Institute–University Health Network; Institute of Medical Science, University of Toronto; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; and Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery.
5. W.E. McIlroy, PhD, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; Toronto Rehabilitation Institute–University Health Network; Graduate Department of Rehabilitation Science, University of Toronto; Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery; and the Brain Sciences Program, Sunnybrook Health Sciences Centre.

Abstract

Background & Purpose Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls. The purpose of the study was to: determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly-used clinical measures of balance, mobility and lower limb impairment.

Methods A retrospective chart review of patients with stroke who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment.

Results Ninety nine of 139 (71%) patients had impaired stepping reactions characterized by: the need for assistance, an inability to step with either lower limb, or the need for multiple step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17–1.43 versus 0.26 to 1.55 m/sec for patients who demonstrated a failed step versus a successful step, respectively.

Conclusions Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge which could possibly increase their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls & to direct appropriate intervention strategies.