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Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

BACKGROUND: A single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and re...

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Autores principales: Bhatt, Tanvi, Dusane, Shamali, Patel, Prakruti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429795/
https://www.ncbi.nlm.nih.gov/pubmed/30902097
http://dx.doi.org/10.1186/s12984-019-0510-3
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author Bhatt, Tanvi
Dusane, Shamali
Patel, Prakruti
author_facet Bhatt, Tanvi
Dusane, Shamali
Patel, Prakruti
author_sort Bhatt, Tanvi
collection PubMed
description BACKGROUND: A single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment. METHODS: Twenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed. RESULTS: On the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control. CONCLUSION: Chronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity.
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spelling pubmed-64297952019-04-04 Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors? Bhatt, Tanvi Dusane, Shamali Patel, Prakruti J Neuroeng Rehabil Research BACKGROUND: A single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment. METHODS: Twenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed. RESULTS: On the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control. CONCLUSION: Chronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity. BioMed Central 2019-03-22 /pmc/articles/PMC6429795/ /pubmed/30902097 http://dx.doi.org/10.1186/s12984-019-0510-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Bhatt, Tanvi
Dusane, Shamali
Patel, Prakruti
Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title_full Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title_fullStr Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title_full_unstemmed Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title_short Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
title_sort does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429795/
https://www.ncbi.nlm.nih.gov/pubmed/30902097
http://dx.doi.org/10.1186/s12984-019-0510-3
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