Amtrak stairs

They are extremely narrow, so you can lean against any side for support. Steps are quite shallow and you really don't have enough room to circumduct your leg to clear the step. So proper stepping is being enforced. Does your therapist have similar interventions?

Amtrak stairs

These are a challenge both up and down. Down the railing is on the left side. Up I have a cup of coffee in hand, so I bounce my shoulders against the wall. Only 3 cups so far and 1 was delivered by a neighbor.  Quite steep.  The walk back to my seat with the train swaying so far hasn't resulted in me spilling my coffee or landing in someone's lap.

Injuries on stairs occur in all age groups and abilities

If we had anything other than fucking failures of stroke associations we would know the exact percentage of falls on stairs in the stroke survivor population. Then we would have a stair walking protocol to prevent such falls.  And since we have NO protocols that get survivors to 100% recovery we aren't even getting them back to their previous state of health. The stroke medical world is forcing survivors to live on one floor with compensation since NO one is even attempting to get survivors to 100% recovery.
http://www.reuters.com/article/us-health-injuries-stairs/injuries-on-stairs-occur-in-all-age-groups-and-abilities-idUSKBN1CE1Z4?feedType=RSS&feedName=healthNews&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+reuters%2FhealthNews+%28Reuters+Health+News%29

(Reuters Health) - More than 1 million Americans injure themselves on stairs each year, according to a study in the American Journal of Emergency Medicine.

Older adults, younger children and women reported more injuries, but all ages show up in emergency departments for sprains, strains, bumps and fractures.

“Stairs are a common source of injury among all ages, and the frequency and rate of stair-related injuries are increasing,” said senior author Dr. Gary Smith of Nationwide Children’s Hospital in Columbus, Ohio.

About half of homes in the United States contain stairs, according to the Census Bureau, and the direct and indirect costs of non-fatal stair injuries total about $92 billion annually, the study team notes.

“This underscores the need for increased prevention efforts, particularly those related to stair design and construction,” Smith told Reuters Health by email.

The researchers analyzed data from the National Electronic Injury Surveillance System on injuries involving stairs that were treated in emergency departments between 1990 and 2012.

They found nearly 25 million patients treated in ERs over those 23 years, representing an average rate of about 38 stair-related injuries per 10,000 U.S. residents annually, which is about 3,000 per day or one injury every 30 seconds.

Injury rates fell by about 13 percent during the early part of the study period, from 1990 to 1996, but then rose by 24 percent from 1996 to 2012, the study found. About 62 percent of patients were women and more than 60 percent of injuries happened at home.

Adults over age 85, children under 3 years old and young adults in their 20s had the highest injury rates, but over two thirds of the emergency department visitors were a mix of ages between 11 and 60 years old.

“This study was unable to identify the reasons for the higher injury rates among women,” the study authors write. “However, these are the child-bearing and parenting years . . . that could include increased exposure to stairs related to greater time in the home while caring for children and performing household chores.”

Nearly 94 percent of patients were treated and released from the hospital, but 6 percent were admitted for treatment of fractures or concussions. The most common types of injuries were sprains, strains, scrapes, bruises and broken bones. Kids under age 10 had more head injuries while older patients had more fractures, which often required hospitalization.

Overall, about 60 percent of injuries happened without a cause, according to the patients’ accounts. Twenty-three percent of patients said they slid, slipped, tripped or misstepped. A small number said they were carrying objects and couldn’t see.

Future research should look at stair design and safety, the study authors write. To help prevent accidents, new stair construction and remodels could increase the horizontal surfaces for the foot to step on, for instance. Horizontal and vertical surfaces should also be uniform to prevent missteps, they note.

An example of a common tripping hazard, the study team, points out, is a missing nosing - the part of the tread that overhangs a stair - on the top step. Stair patterns may also throw off people at the last step, causing a bottom-of-stair illusion.

“The term ‘slips, trips and falls’ is a major misstatement of the full complexity of all possible missteps,” said Jake Pauls, a building safety consultant in Toronto, Canada, and Silver Spring, Maryland, who researches stairway safety and usability but wasn’t involved in the study.

“Underlying societal factors have led (in all countries) to a double standard and lower standard for home stairways compared to those in all other settings (such as workplaces),” Pauls told Reuters Health by email.

Handrails with a “power grip,” which allows the entire hand to grab the rail rather than just the fingers, reduce more severe injuries during a fall. Slippery surfaces and loose carpeting can cause issues, too.

“Revising building codes and updating existing stairways to comply with geometric dimensions are recommended for optimal safety,” Smith said. “People can also reduce injuries by keeping stairs clear of clutter, ensuring stairways are well-lit and not multitasking while navigating the stairs.”
SOURCE: bit.ly/2yNBGax American Journal of Emergency Medicine, online September 20, 2017.

Flights of stairs in France

Don't even attempt to go to France if you can't handle lots of steps. The Metro has lots of steps, few escalators and even fewer elevators. One of the transfers required a 90 step march up a spiral staircase although it did point to an elevator. Restaurants have usually put the toilette in the basement with a steep staircase leading downward, not always with railings. The hotel in Paris stairway looked like this. I would go down it but not up. Mainly because there was no railing on the right on the way up. It traverses from floor to floor in a half circle.

Paris hotel stairs

Paris hotel stairs

Paris hotel stairs

Total of 421 flights of stairs during the trip, high days were 53 and 55 floors.

One of the museums had s spiral staircase like this. I reached across my body with my good right hand to grab the railing. My left hand is worthless for this, it doesn't slide and I have to yank it off whatever it is clamped on.

Museum stairs

Want a younger brain? Stay in school — and take the stairs

I take the stairs as often as possible even though doing so is incredibly slow because I have to think out the complete process. See here for what your stair climbing should look like. What protocol is your doctor following to have you get a younger brain?
http://loonylabs.org/2016/03/09/younger-brain-school-stairs/
The researchers found that brain age decreases by 0.95 years for each year of education, and by 0.58 years for every daily flight of stairs climbed — i.e., the stairs between two consecutive floors in a building.

Characteristics of individuals with hemiparesis according to perception about the difficulty climb stairs

Fucking worthless research. No mention of actually looking at the dead and damaged areas in the brain to correlate disabilities with the damaged brain area. Does no one understand cause and effect?
They seemed not to consider Anosognosia the inability to see your disability.
http://www.mtprehabjournal.com/files/v13nx/mtpAO1315269.pdf

Fernando Wendelstein Cano

1

, Daniela Parizotto

1

, Stella Maris Michaelsen

1

ABSTRACT
Introduction: climbing up and down stairs is entered directly into the Community ambulation and activities of daily living. In individuals with hemiparesis after stroke, this activity may be compromised due to deficits in components of body function and structures, activity and participation.
Objective: To identify the characteristics of individuals with hemiparesis, according to the self-perception of difficulty climbing stairs and relate to components of body function and structures (BFS), activity and participation with the cadence of up / down stairs.
Method: Twenty-five subjects (57.8±12.4 years) with chronic hemiparesis (57.8±42.7 months) were divided into two groups as perceived with and without difficulty climbing stairs by this particular question in the Stroke Specific Quality of Life Scale (SSQOL). In the BSF domain was rated lower limb motor impairment (Fugl-Meyer Scale), the activity domain, gait/mobility (gait speed, the Timed Up and Go-TUG) and balance (one-leg support and BERG) and participation domain the quality of life with SSQOL.
Results: The group with self-perception without difficulty showed less motor impairment and higher levels of activity and participation. Strong correlations of the stair climbing cadence with the Fugl-Meyer Scale and TUG and between stair descent cadence with gait speed and TUG.
Conclusion: Variables of body function and structures , activity and participation are lower in the group with self-perceived difficulty in stair climbing and are correlated with the cadence of stair ascent and descent.

FitBit - Hot Air Balloon badge - Your lifetime floor count has hit 2000

As long as my feet don't pain me too much, this walking is helping me keep my weight in check. My spasticity in my left leg still doesn't allow a smooth step upward. I would expect any PT in the world that works on stroke would know exactly how to correct that problem. But I know damn well that isn't happening.
With this series of images from Nathan Nicholson I finally got the understanding that you don't just lift the foot straight up, you  engage your hamstring to pull your leg up behind you at the same time pointing your toes down(plantarflexxing) to clear the lip of the step. I have to plan this all out on my own since most of my premotor cortex is dead. This currently is a very slow process.
1. Engage the hamstring
2. Point the toes down - plantarflexing 
3. Clear the step
4. Dorsiflex to lift the toe up
5. Straighten the leg