The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals

Background: Individuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width.

Methods: Gait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (H_R) and pelvis and trunk sway.

Findings: Controls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased H_R, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment.

Interpretation: These results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase H_R, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.