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| Rebecca Dutton Home After a Stroke |
Walking in PT gyms and on a deserted sidewalk did not prepare me for walking in community settings, like maneuvering around carts and people in a grocery store, squeezing past closely placed chairs and tables in a restaurant, and dealing with children in a shopping mall who do not look where they are going. PTs do not know walking requires divided attention because they walk clients in wide empty spaces that provide no cognitive challenges. Equally unfortunate, OTs who are trained to assess and treat cognitive issues do not assess community ambulation because walking is PTs domain. So community ambulation falls through the cracks. Stroke survivors are left to figure out how to walk safely in the community.
A recent study addresses the unpredictability of walking in the community. Inness learned what stroke survivors did when they were not told they were about to experience a fall hazard (1). Stroke survivors were asked to stand with each foot on one of two force plates. At an unexpected time the two force plates were tipped forward and subjects had to recover their balance by stepping forward onto a third force plate. Clinical tests like walking speed and the Berg Balance Test did not have a significant correlation with the unexpected stepping test results. Subjects who did poorly or did well on the unexpected stepping test had a similar range of Berg Balance scores (25-55 and 20-56). The Berg Test does not measure real world balance because clients can concentrate fiercely on their own body and get to decide when they want to initiate movement.
Bottom Line: Being afraid to walk in crowded environments is a major barrier to participating in valued community activities. Limiting gait training to walking in the home contributes to social isolation and depression.
- Inness E, Mansfield A, Lakhani B, Bayley M, McIlroy W. Impaired reactive stepping among patients ready for discharge from inpatient stroke rehabilitation.
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