Who takes a recovery step? Predictors of step execution after tripping in individuals with stroke

A recovery step is a crucial balance reaction that prevents falls in individuals with stroke. However, the characteristics of this response after tripping remain unclear, particularly regarding which limb is used for stepping and the factors associated with whether a step is taken.

This study aimed to identify the factors associated with whether a recovery step was taken following a trip to support the development of effective fall prevention strategies for individuals with stroke.

A large-scale motion capture database comprising 41,943 gait trials was analyzed to identify near-falls caused by paretic toe tripping in 42 patients with subacute stroke. Logistic regression analysis was conducted to examine the influence of physical function, walking-aid use, and near-fall velocity during tripping on step execution.

Recovery steps were observed in 48 % of the participants, and 95 % of these steps were initiated with the non-paretic limb. The key factors associated with the occurrence of recovery steps included right-sided hemiparesis (p = 0.085), nonuse of a cane (p = 0.028), and higher fall velocity (p = 0.007). The full logistic regression model demonstrated good predictive ability, with an area under the curve of 0.850.

Individuals with stroke predominantly rely on the non-paretic limb for recovery stepping. The side of hemiparesis, cane use, and near-fall velocity were identified as key factors associated with step occurrence. These findings support the facilitation of recovery stepping through individualized training with rapid disturbances during independent walking in individuals with stroke.