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Objective. A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. Methods. This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. Results. Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. Conclusion. A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. Impact. Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk., Falls, a common secondary complication after a stroke, (1) can result in a fracture, (2) increased fear of falling, (3) and more sedentary behavior. (3) The combined residual sensorimotor deficits [...]

Falls are a significant public health concern worldwide, particularly for older adults. In this study, we aim to create an effective quantitative indicator for long-term daily fall risk assessment suitable for use with in-shoe motion sensors (IMSs). We used the likelihood of an individual being a faller (ranging from 0 to 1) as a representation of the quantitative fall risk indicator. This indicator was constructed using data from 40 nonfallers and 24 fallers, all female older adults with distal radius fractures (DRFs) caused by falls within 6 months (denoted as 0 and 1, respectively). The indicator was determined using Fisher’s discriminant, naïve Bayesian, or logistic regression approaches. Predictors were derived from four types of gait parameters and four types of physical ability metrics, all of which can be measured or estimated using IMS-measured gait. To prevent overfitting, we performed principal component analysis (PCA) on the predictors. To validate our method, we assessed Pearson’s correlation between clinical experts-rated fall risk scores and the constructed fall risk indicator using a separate group of 19 older female adults. The Pearson’s correlation obtained was 0.766. We successfully developed a fall risk indicator using IMS-measured gait, demonstrating the potential for IMSs to achieve long-term daily fall risk assessment.