Key result
Polio survivors show impaired walking adaptability with ~6 mm worse stepping accuracy than healthy controls.
Why the study?
Falling is a major health problem in polio survivors, often resulting from tripping, slipping, or misplaced steps, suggesting reduced walking adaptability may play an important role.
Does walking adaptability (target-stepping accuracy and obstacle avoidance), assessed on an interactive treadmill, differ between polio survivors with a history/fear of falling and healthy individuals of similar age?
Cross-Sectional (n=71)
No
Does walking adaptability (target-stepping accuracy and obstacle avoidance), assessed on an interactive treadmill, differ between polio survivors with a history/fear of falling and healthy individuals of similar age?
Polio survivors with a history or fear of falling exhibit significantly impaired walking adaptability—particularly during time-pressured reactive obstacle avoidance—which may help explain their high fall risk and inform clinical fall-risk assessments.
Impaired adaptability may inform fall-risk assessment in polio survivors; leaves open whether targeted training improves outcomes.
BACKGROUND: Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role. RESEARCH QUESTION: Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals? METHODS: In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection. RESULTS: 46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001). SIGNIFICANCE: Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.
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Tuijtelaars et al. (2021) conducted a cross-sectional in Poliomyelitis survivors with fall risk (n=71). Prior poliomyelitis with fall history and/or fear of falling vs. Community-dwelling healthy individuals of similar age was evaluated on Walking adaptability: target-stepping accuracy (variable stepping error [VE] in mm, speed-adjusted) and anticipatory/reactive obstacle avoidance success rates (%) (p=0.001). Polio survivors had poorer target-stepping accuracy (VE 36.4 vs 30.6 mm, p=0.001) and lower obstacle avoidance (anticipatory 83% vs 100%, reactive 59% vs 94%, p<0.001) than healthy controls.
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