Age-related differences in reactive balance control and fall-risk in people with chronic stroke

Background: Impaired reactive responses to sudden environmental perturbations contribute to heightened fall-risk in healthy aging and neurologically impaired populations. Previous studies have demonstrated individual contributions of paretic and non-paretic sides to fall-risk in people with stroke with variable levels of motor impairment. However, the combined effect of aging and unilateral cortical lesion on reactive balance control is not clearly understood. We therefore aimed to examine age-related differences in reactive balance control and fall-risk during laboratory-induced gait-slips in people with comparable stroke-related motor impairments. Methods: Thirteen younger (45.61 ± 4.61 years) and thirteen older (71.92 ± 6.50 years) adults with similar stroke-related impairment (on Fugl-Meyer Lower Extremity Assessment) were exposed to one overground gait-slip under each limb (paretic and non-paretic). Center of mass state stability and slipping kinematics (slip displacement and velocity) were computed. Clinical balance and mobility were also assessed. Results: On non-paretic slips, older adults with chronic stroke demonstrated greater falls and lower center of mass stability (its position and velocity) at post-slip touchdown compared to younger adults with chronic stroke (p < 0.01). This was accompanied with a greater peak slip displacement and faster peak slip velocity (p < 0.01). However, there were no such group differences noted on the paretic slips (p > 0.01). Conclusion: Aging may have an independent, detrimental effect on reactive balance control in people with chronic stroke. Non-paretic deficits in controlling slip intensities (slip displacement and velocity) can accentuate fall-risk in older adults with chronic stroke. Further investigation is necessary to identify additional factors attributing to heightened fall-risk in older adults with chronic stroke.