Tracking the Development and Influence of Post-Stroke Sensory Reweighting on Walking and Balance Outcomes
University of Cincinnati
Summary
The primary objective of this proof-of-concept study is to longitudinally track the development of post-stroke sensory reweighting (PSR), identify associated structural neuroanatomical correlates, and investigate their relationship to walking and fall outcomes.
Description
Post-stroke imbalance and walking impairment is a function of diminished sensorimotor integration, motor, and postural control. It impacts over 75% of stroke survivors, and remain a rising cause of falls, fractures, and death in the United States. The associated fear of falling often leads to a downward spiral of health, characterized by reduced walking performance, caregiver dependency, social isolation, and the development of secondary post-stroke medical complications. Although spontaneous biological recovery and intensive clinical rehabilitation may improve balance and walking ability, the…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. First ever clinical stroke 2. Stroke due to ischemia 3. Age 18 years or older 4. Ability to consent by patient (not surrogate), any time prior to acute hospital discharge Exclusion Criteria: 1. Pre-stroke dependence (modified Rankin Scale score of 3 or more) 2. Isolated brainstem or cerebellar stroke 3. Bilateral acute strokes 4. Co-enrollment in a trial of an intervention through six-month follow-up 5. Inability to maintain follow-up with study procedures through six-month follow-up 6. Contraindication to non-contrast MRI 7. Low likelihood of survival beyond the acut…
Interventions
- Diagnostic TestPosturography
Successful completion of all four indices of the mCTSIB, without severe imbalance (i.e., near fall with safety harness and urgent knee to grab emergency handlebars) constitutes "PSR +", non-completing on any of the index is noted as "PSR -". Exploratorily, the average sway velocity index will be captured for each condition, to characterize sensory reweighting patterns.
- Diagnostic TestWalking Speed
The 10-meter walk test (10MWT) is the gold standard measure of post-stroke walking function that reflects overall mobility and health status. Method: Two 10MWT trials (using a stopwatch) are averaged and documented in meters/second. The functional ambulatory category (FAC) will be collected as supplement. Exploratorily: Participants will also perform the 10mWT (fast paced-FP) with two attempts. Both SS and FP will be performed over the Zeno Walkway Gait Analysis Mat, to capture supplementary spatiotemporal data.
- Diagnostic TestInstrumented 7M Timed UP and GO
This sub-aim will use iTUG to determine the effects of BLT on dynamic balance. In contrast to the traditional TUG, inclusion of wearable triaxial accelerometers and gyroscopes-placement test increases the sensitivity (87%) and specificity (87%) for identifying individuals prone to falls. Two trials are averaged and documented in seconds. Secondary analysis will be performed on data obtained from the sensors to determine (stride length, stride velocity, cadence, peak arm swing velocity, and turning velocity, during the task), to correlate with the TUG time/speed. Time points: Same as Posturography and 10 MWT.
- Other
Location
- University of Cincinnati College of MedicineCincinnati, Ohio