Abnormal Gait Movements Prior to a Near Fall in Individuals After Stroke

OBJECTIVE: To investigate the abnormal kinematic and kinetic movements in the last gait cycle before a near fall in individuals poststroke, where a near fall is defined as a physical therapist feeling the need to stabilize a patient. DESIGN: Retrospective study. SETTING: A rehabilitation center. PARTICIPANTS: Twenty-five adults (22 men, 3 women; N=25) with an average age of 66.3 years and mean duration from stroke of 4 months who required manual assistance for a sudden imbalance during routine 3-dimensional motion analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We compared the averaged usual gait cycle and the last cycle before the near-falling gait cycle (pre–near-falling gait cycle). We obtained the following spatiotemporal parameters: gait velocity, gait cycle duration, mediolateral center of mass displacement, step length, step width, joint moments, and angular displacement of the trunk in a cycle. Peak values of joint moments and trunk angle displacement were calculated. RESULTS: Etiology for near falls included toe trip, mediolateral perturbation, and knee collapse. We found the following significant differences in the pre–near-falling gait cycle compared with the usual gait cycle: decreased gait velocity, prolonged total cycle time, and excessive mediolateral center of mass displacement. CONCLUSIONS: Decreased gait velocity, prolonged cycle time, and excessive mediolateral center of mass displacement may be a sign of an impending fall in people with impaired gait after stroke.