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

Abstract

Background. Obstacle crossing is impaired in people 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. The purposes of this study were (1) to identify whether a group of people with stroke who failed an obstacle crossing task had a greater incidence of falling and (2) to determine whether people who fail an obstacle crossing task utilize different gait adjustments. Design. This 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, center of mass (COM), and center of pressure (COP) data were collected. Prospective falls data were recorded for 20 participants over a 6-month period. Results. The incidence of fallers was significantly higher (incidence rate=0.833) in the group that failed the obstacle crossing task than in the group that passed the task (incidence rate=0.143). The group that failed the task had a slower walking speed and greater normalized separation between the trail heel (unaffected support limb) and COM as the affected lead toe cleared the obstacle. This group exhibited greater normalized times from affected lead toe clearance to landing, unaffected trail toe clearance to landing, and affected trail toe-off to toe clearance. Limitations. The sample size was small, and falls data were available for only 20 participants. Conclusions. Obstacle crossing is an important task to consider in people following stroke and may be useful in identifying those at risk of falls. © 2013 American Physical Therapy Association.