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J Phys Ther. 2013; 7(2): 50-59

Impaired reactive stepping is a prevalent problem for patients at discharge from inpatient stroke rehabilitation- a retrospective study

Elizabeth L. Inness, BScPT., MSc; a,b Avril Mansfield, PhD;a-c Bimal Lakhani, MSc;b Mark Bayley, MD;a,c William E. McIlroy, PhDa-d.

Background & Purpose 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 into the community and the relationship to patient performance on commonly-used clinical measures of balance, mobility
and lower limb impairment.
Methods A retrospective chart review of patients with stroke who, at time of discharge, had completed a perturbation-evoked reactive
stepping assessment.
Results Sixty-seven of 93 (72%) 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 statistical 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
scores ranged from 29 to 55 out of 56 and gait speeds ranged from 0.171.43 m/sec for patients who demonstrated a failed step.
Conclusions Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge which could
possibly increase 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 & to direct appropriate intervention

Key words: falls, balance perturbation, stroke rehabilitation

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