Hollands, Kristen (2010)
Ph.D. thesis, University of Birmingham.
This body of work sought to explore kinematic impairments which may underlie falls incidences during turning following stroke and review the evidence for the effectiveness of interventions aimed at improving aspects of locomotor coordination which are key to controlling turning. A systematic review of the literature identified insufficient homogeneity of high quality evidence to determine if task specific locomotor practice interventions are effective in improving aspects of gait coordination which are key to the controlling turning. The review highlighted a need for a better understanding of the nature of coordination deficits in functional walking tasks, such as turning, after stroke. In order to provide a base of knowledge regarding abnormalities in the coordination of locomotor patterns during turning while walking, two experimental studies were undertaken. The studies employed analysis of full-body kinematics during turns made under pre-planned and reactive conditions as well as turns of different magnitudes and those made by participants with and without a falls history. Findings from Study 1 showed a strong trend for participants with stroke (in particular those with lesions involving the basal ganglia) to initiate pre-planned turns later than their age-match counterpart. Turns made in response to an external cue were made in a similar manner to healthy controls. Results from study 2 indicate that while participants with stroke and falls history took significantly longer to turn, all other aspects of the movement pattern were similar to healthy controls and non-fallers. Therefore, incidences of falls during turning following stroke may not be due to impaired movement patterns alone. On this basis, we suggest that rehabilitation efforts and further studies should address the interplay of impaired movement production with other factors such as attention.
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