People with stroke who fail an obstacle crossing task have a higher incidence of falls and utilise different gait patterns compared with people who pass the task

Abstract

Background: Obstacle crossing is impaired following stroke. It is not known whether people with stroke who fail an obstacle crossing task have more falls, or whether the gait adjustments used to cross an obstacle differ from those used by people who pass the task.

Objective: To identify whether a group of people with stroke who failed an obstacle crossing task had a greater incidence of falling, and to determine whether people who fail an obstacle crossing task utilise different gait adjustments.

Design: This study was a prospective observational study.

Methods: Thirty-two participants with a recent stroke were recruited. Participants walked at self-selected speed and stepped over a 4-cm high obstacle. Performance was rated as pass or fail, and spatiotemporal, centre of mass (COM) and centre of pressure (COP) data were collected. Prospective falls data were recorded for 20 participants over a six month period.

Results: The incidence of fallers in the group that failed the obstacle crossing task was significantly higher (IR =.833) than the group that passed (IR = .143; p = .007). The group that failed had a slower walking speed and greater normalised separation between the trail heel (unaffected support limb) and COM as the affected lead toe cleared the obstacle. This group exhibited greater normalised times from affected lead toe clearance to landing, unaffected trail toe clearance to landing and affected trail toe off to toe clearance.

Limitations: Sample size was small, and falls data were only available for 20 participants.

Conclusions: Obstacle crossing is an important task to consider following stroke and may be useful in identifying those at risk of falls.