Determinants of limb preference for initiating compensatory stepping poststroke

Area of Science:

• Neurorehabilitation
• Biomechanics
• Stroke recovery

Background:

• Post-stroke hemiparesis frequently impairs balance and increases fall risk.
• Compensatory stepping is a crucial response to prevent falls after a postural perturbation.
• Understanding limb preference in compensatory stepping is vital for rehabilitation strategies.

Purpose of the Study:

• To identify factors influencing the choice of limb for initiating compensatory stepping after stroke.
• To explore the relationship between paretic limb function and stepping responses.

Main Methods:

• Retrospective chart review of individuals with poststroke hemiparesis undergoing inpatient rehabilitation.
• Compensatory stepping responses were elicited using a lean-and-release postural perturbation.
• Analysis of limb preference for stepping, premorbid dominance, weight bearing, and motor recovery scores.

Main Results:

• The majority of compensatory steps (59.1%) were initiated with the non-paretic limb.
• Higher lower-limb motor recovery scores and greater pre-perturbation weight bearing on the non-paretic limb were associated with increased paretic limb stepping.
• Blocking the preferred limb led to inappropriate responses in 21% of trials.

Conclusions:

• Individuals with poststroke hemiparesis face significant challenges in using the paretic limb for compensatory stepping.
• Difficulties in executing paretic limb steps may elevate the risk of falls in this population.
• These findings highlight the need for targeted interventions to improve compensatory stepping in stroke survivors.