Stroke impairs the proactive control of dynamic balance during predictable treadmill accelerations

We maintain balance during gait using both proactive and reactive control strategies. Damage to the brain from a stroke impairs reactive balance, but little is known about how a stroke impacts proactive control during walking. Identifying stroke-related impairments to proactive control could inform the design of interventions to improve balance and reduce fall risk. Therefore, we determined if people with and without stroke differ in their ability to use proactive strategies during predictable treadmill accelerations. Groups of 14 adults with and without stroke walked with single-belt accelerations at random (every one to five strides) and regular (every three strides) intervals. We quantified the effects of the perturbations as changes to center of mass (COM) speed and used mechanical leg work to quantify the proactive strategies to slow the COM. Participants without stroke reduced peak COM speed better than those with stroke when perturbations were at regular intervals (-0.023 versus -0.001 m/s; p=0.007). They also reduced positive leg work more during the perturbation step than the group post-stroke (-7.7% versus - 1.9%; p=0.004). Together, these results demonstrate that the sensorimotor impairments resulting from a stroke impair the ability to generate effective proactive adjustments to reduce the destabilizing effects of predictable perturbations.