Effects of Targeted Assistance and Perturbations on the Relationship Between Pelvis Motion and Step Width in People With Chronic Stroke

During walking in neurologically-intact controls, larger mediolateral pelvis displacements or velocities away from the stance foot are accompanied by wider steps. This relationship contributes to gait stabilization, as modulating step width based on pelvis motion (hereby termed a “mechanically-appropriate” step width) reduces the risk of lateral losses of balance. The relationship between pelvis displacement and step width is often weakened among people with chronic stroke (PwCS) for steps with the paretic leg. Our objective was to investigate the effects of a single exposure to a novel force-field on the modulation of paretic step width. This modulation was quantified as the partial correlation between paretic step width and pelvis displacement at the step’s start (step start paretic ρ(disp)). Following 3-minutes of normal walking, participants were exposed to 5-minutes of either force-field assistance (n = 10; pushing the swing leg toward mechanically-appropriate step widths) or perturbations (n = 10: pushing the swing leg away from mechanically-appropriatestep widths). This period of assistance or perturbations was followed by a 1-minute catch period to identify after-effects, a sign of altered sensorimotor control. The effects of assistance were equivocal, without a significant direct effect or after-effect on step start paretic ρ(disp). In contrast, perturbations directly reduced step start paretic ρ(disp) (p = 0.004), but were followed by a positive after-effect (p = 0.02). These results suggest that PwCS can strengthen the link between pelvis motion and paretic step width if exposed to a novel mechanical environment. Future work is needed to determine whether this effect is extended with repeated perturbation exposure.