Reactive Balance Control after Stroke: Towards Enhanced Clinical Understanding and Assessment

Safe and independent mobility is a primary rehabilitation goal for those with stroke, of which balance control is a key determinant. The risk of falls post-stroke is high and fall rates rise dramatically soon after discharge from the hospital. Previous research has revealed the essential role that reactive balance control, specifically the capacity to initiate and execute a rapid step, has in preventing falls. Of concern, reactive balance control is not routinely assessed within physical therapy practice. Challenges to clinical assessment may include a lack of available methods that are safe, standardized and able to quantify and characterize balance responses. Therefore, this dissertation aimed to advance understanding of reactive stepping after stroke to inform and guide clinical assessment practices. The present findings affirmed that reactive stepping post-stroke is a significant problem not clearly revealed by commonly-used clinical measures that focus on voluntary control, thereby, supporting the need to develop targeted assessments of reactive balance control. Further, the findings revealed the potential for clinical uptake of alternate approaches, specifically the lean-and-release method, to assess reactive stepping among those in early stages of stroke rehabilitation. When paired with kinetic measurement technology, such approaches were able to quantify and reveal determinants of temporal dyscontrol of both the paretic and nonparetic lower-limbs, known to be associated with falls after stroke. Further work is warranted to evolve the lean-and-release assessment towards a more useful clinical tool, suitable for widespread clinical uptake.Ph.D