Impaired Reactive Stepping Among Patients Ready for Discharge From Inpatient Stroke Rehabilitation

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 authors aimed to study the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were to discharge from inpatient rehabilitation and the relationship to patient performance on commonly used clinical measures of balance, mobility, and lower limb impairment. They did a retrospective analysis of patient admissions over a 3-year period. Charts were reviewed for patients who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment. Reactive stepping was evaluated using a “lean-and-release” balance perturbation method.

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.

Impaired reactive stepping possibly increases the risk of falling in stroke patients getting discharge from inpatient rehab 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.