Immediate effect of voluntary-induced stepping response trainingon the compensatory protective step in persons with stroke

Abstract

We aim to compare voluntary-induced stepping response (VSR) characteristics between young, elderly and persons with stroke (objective 1) and examine the immediate effect of VSR on protective steps, compared to DynSTABLE perturbation training (DST), in patients with stroke (objective 2). Ten young, 10 elderly, and 10 patients with stroke were assessed with VSR for 10 trials for objective 1. VSR was generated by voluntarily leaning forward until losing balance and take only a step. Then, a randomized controlled trial was conducted in 34 patients with chronic stroke (VSR=17 and DST=17) for objective 2. All participants received 1 session of VSR or DST training for 50 minutes. Protective steps were assessed prior to and immediately after training. We found that step kinematics, stability, and strategies of responses were more impaired in participants with stroke than young and elderly. Both training groups resulted in increased step width, but step length and stability increased more following DST. A Single step incidence increased significantly in both groups but the affected stepping increased only after VSR training. We concluded that VSR was impaired in persons with stroke. Normal characteristics of young can be used as guidelines for rehabilitation. As a single-day VSR training improved protective steps similar to DST, it may provide an alternative option to equipment-based training.

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