Article

Individuals with stroke are at increased risk for falls soon after
hospital discharge. The ability to react to a balance perturbation, specifically
with a rapid step, is critical to maintain balance and prevent falls.
The purpose of the study was to determine the prevalence of impaired reactive
stepping responses in an ambulatory group of patients with stroke who were
preparing for discharge from inpatient rehabilitation and the relationship to
patient performance on commonly used clinical measures of balance, mobility, and
lower limb impairment. This study was a retrospective analysis of patient
admissions over a 3-year period. METHODS: Charts were reviewed for patients who,
at time of discharge, had completed a perturbation-evoked reactive stepping
assessment. RESULTS: Ninety-nine (71%) of 139 patients had impaired stepping
reactions characterized by the need for assistance, an inability to step with
either lower limb, or the need for multiple-step responses. There was a
statistically significant difference in clinical scores between those with and
without impaired stepping, but groups were characterized by considerable
variation in clinical profiles. For example, Berg Balance Scale scores ranged
from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17 to 1.43 versus
0.26 to 1.55 m/s for patients who demonstrated a failed step versus a successful
step, respectively. LIMITATIONS: Not all patients who attended stroke
rehabilitation received a reactive stepping assessment at discharge. CONCLUSIONS:
Impaired reactive stepping is a prevalent problem for ambulatory patients with
stroke preparing for discharge, possibly increasing their risk of falling when
faced with the challenges of community ambulation. Specific tests that target the
capacity to perform perturbation-evoked stepping reactions may be important to
identify those at risk for falls and to direct appropriate intervention
strategies.
CI - (c) 2014 American Physical Therapy Association.

Langue : ANGLAIS