Cargando…

Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke

INTRODUCTION: People with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people...

Descripción completa

Detalles Bibliográficos
Autores principales: Staring, Wouter H. A., van Duijnhoven, Hanneke J. R., Roelofs, Jolanda M. B., Zandvliet, Sarah, den Boer, Jasper, Lem, Frits C., Geurts, Alexander C. H., Weerdesteyn, Vivian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714322/
https://www.ncbi.nlm.nih.gov/pubmed/36465583
http://dx.doi.org/10.3389/fspor.2022.1008236
_version_ 1784842198203760640
author Staring, Wouter H. A.
van Duijnhoven, Hanneke J. R.
Roelofs, Jolanda M. B.
Zandvliet, Sarah
den Boer, Jasper
Lem, Frits C.
Geurts, Alexander C. H.
Weerdesteyn, Vivian
author_facet Staring, Wouter H. A.
van Duijnhoven, Hanneke J. R.
Roelofs, Jolanda M. B.
Zandvliet, Sarah
den Boer, Jasper
Lem, Frits C.
Geurts, Alexander C. H.
Weerdesteyn, Vivian
author_sort Staring, Wouter H. A.
collection PubMed
description INTRODUCTION: People with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT. METHODS: We performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality. RESULTS: We observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle. CONCLUSION: PBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT.
format Online
Article
Text
id pubmed-9714322
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-97143222022-12-02 Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke Staring, Wouter H. A. van Duijnhoven, Hanneke J. R. Roelofs, Jolanda M. B. Zandvliet, Sarah den Boer, Jasper Lem, Frits C. Geurts, Alexander C. H. Weerdesteyn, Vivian Front Sports Act Living Sports and Active Living INTRODUCTION: People with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT. METHODS: We performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality. RESULTS: We observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle. CONCLUSION: PBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT. Frontiers Media S.A. 2022-11-17 /pmc/articles/PMC9714322/ /pubmed/36465583 http://dx.doi.org/10.3389/fspor.2022.1008236 Text en Copyright © 2022 Staring, van Duijnhoven, Roelofs, Zandvliet, den Boer, Lem, Geurts and Weerdesteyn. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Sports and Active Living
Staring, Wouter H. A.
van Duijnhoven, Hanneke J. R.
Roelofs, Jolanda M. B.
Zandvliet, Sarah
den Boer, Jasper
Lem, Frits C.
Geurts, Alexander C. H.
Weerdesteyn, Vivian
Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title_full Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title_fullStr Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title_full_unstemmed Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title_short Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
title_sort improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke
topic Sports and Active Living
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714322/
https://www.ncbi.nlm.nih.gov/pubmed/36465583
http://dx.doi.org/10.3389/fspor.2022.1008236
work_keys_str_mv AT staringwouterha improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT vanduijnhovenhannekejr improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT roelofsjolandamb improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT zandvlietsarah improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT denboerjasper improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT lemfritsc improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT geurtsalexanderch improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke
AT weerdesteynvivian improvementsinspatiotemporaloutcomesbutnotinrecruitmentofautomaticposturalresponsesarecorrelatedwithimprovedstepqualityfollowingperturbationbasedbalancetraininginchronicstroke