The long-term objective of this research is to develop an efficacious training paradigm to enhance stroke survivors' defense mechanisms against falls and possibly reduce healthcare cost. The Centers for Disease Control and Prevention estimates the direct medical cost for fall related injuries to be $34 billion annually. Forty percent to 70% of community-dwelling stroke survivors experience detrimental falls each year and tend to have 1.5 to 4 times higher risk of hip fracture than their healthy counterparts; with only less than 40% of those individuals regaining independent mobility. Falls, thus not only affect activities of daily living but also reduce mobility, increase risk of second stroke and mortality. Despite potential financial and functional implications of falls in this population, health-care personnel are limited in their ability to develop and validate interventions to reduce fall-risk for them. Further emphasis is placed on locomotor training with focus on enhancing paretic limb function. The project design consists of a randomized controlled trial to examine the ability of chronic stroke survivors to acquire, generalize and retain adaptations to slip-perturbation training for not only mitigating fall risk but also improving walking function. It also explores translation of this paradigm to the sub-acute population. The paradigm is novel in that it targets contributions of the paretic vs. non-paretic limbs on fall-risk through a bilateral training paradigm that involves training the non-paretic side first and then paretic to facilitate acquisition of fall-prevention skills on the paretic side, which may otherwise take longer to acquire training effects. The longer-term benefits of such perturbation training, targeting both limbs for reducing falls will be assessed not only in the laboratory but also in real life via wearable sensors, along with improved community walking function. The hypothesis of this study if supported by the results will provide an evidence-supported training protocol to reduce the fall-risk not only in people living with hemiparetic stroke but also among survivors of other acquired unilateral cortical lesions.

Public Health Relevance

The proportion of stroke survivors continues to increase as a result of improvement in post-stroke life expectancy due to advances in the medical field. These survivors, especially if ambulatory, are at the greatest risk of experiencing environmental falls. The subsequent societal impact from the physical and psychosocial consequences of falls is particularly high - leading to morbidity and mortality in this population. The proposed study addresses this major health care concern by targeting fall prevention via enhancing stroke survivors' defense mechanisms to environmental perturbations encountered in daily living such as slips. Reduced incidence of falls could improve mobility and quality of life among these survivors, and possibly reduce risk of second stroke, mortality and overall healthcare cost.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD088543-03
Application #
9770563
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Cruz, Theresa
Project Start
2016-09-23
Project End
2022-07-31
Budget Start
2019-08-01
Budget End
2020-07-31
Support Year
3
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Illinois at Chicago
Department
Other Health Professions
Type
Sch Allied Health Professions
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612