Characteristics of proactive balance and gait performance in subacute stroke patients demonstrating varying reactive balance capacity: A research study

Article type: Research Article

Authors: Handelzalts, Shirley^{a; b; 1} | Gray, Ganit^{a; b; 1} | Steinberg-Henn, Flavia^{a; b} | Soroker, Nachum^{b; c} | Melzer, Itshak^{a; *}

Affiliations: [a] Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel | [b] Loewenstein Rehabilitation Hospital, Ra’anana, Israel | [c] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Correspondence: [*] Address for correspondence: Itshak Melzer PhD PT, Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel. Tel.: +972 (0)8 647 7375; Fax: +972 (0)8 647 7683; E-mail: [email protected].

Note: [1] GG and SH contributed equally to this work.

Abstract: BACKGROUND:Persons with stroke (PwS) demonstrate impaired reactive balance control placing them at increased risk of falls. Yet, tests used in clinical practice to assess this risk usually rely on proactive balance control. OBJECTIVE:To investigate differences in proactive balance in PwS with varying reactive balance capacity. METHODS:Reactive balance control was assessed in 48 first-event subacute PwS by measuring multiple-step threshold and fall threshold in response to unannounced surface perturbations. They were classified as low-, medium- high- threshold fallers and non-fallers in accordance with the perturbation magnitude at which they were unable to maintain balance (fall threshold). Proactive balance control and gait performance were tested using the Berg Balance test, 10-meter walk test, 6-minute walk test and the Activities-specific Balance Confidence Scale (ABC). RESULTS:PwS who demonstrated poor reactive balance capacity were also more impaired in their proactive balance and gait. Proactive balance and gait performance were significantly different between the 4 groups while ABC was not. The associations between reactive and proactive measures of balance were moderate (r = 0.53–0.67). CONCLUSIONS:The moderate correlations between reactive and proactive balance control suggest the recruitment of different neural mechanisms for these two operations, highlighting the importance of assessing and treating reactive balance in clinics.

Keywords: Stroke, falls, balance reactive control, balance proactive control, fall threshold, gait

DOI: 10.3233/NRE-203039

Journal: NeuroRehabilitation, vol. 46, no. 4, pp. 491-500, 2020