Of the approximately 800,000 people who have strokes each year in the United States, 70% will ultimately have residual walking impairments such as reduced speed or compromised endurance. These and other sensorimotor impairments can dramatically impair mobility, increase fall risk, and reduce an individual's overall quality of life. One of the central challenges for developing individualizing rehabilitation strategies to mitigate impairments and reduce fall risk is that there is a lack of objective measures of fall risk capable of assessing a patient's ability to recover from a loss of balance. In addition, even if a measure could predict whether a given patient will sustain a future fall, there are myriad physical and psychological factors contributing to fall risk and these factors likely covary with one another.

Here, we will propose a pilot study that seeks to 1) establish the validity of an objective biomechanical assessment of fall risk that directly measures a patient's ability to recover from a loss of balance, 2) determine which patient-specific physical and psychological factors are associated with measures of fall risk, and 3) determine if shifting a patient's walking pattern toward the typical pattern observed in healthy individuals leads to improvements in balance. To achieve our objectives, we have assembled a team of experts in gait analysis, biomechanics, post-stroke rehabilitation, and evidence-based physical therapy to maximize our likelihood of success. The results from our pilot study will be used as preliminary data to support two aims of a future R01 application whose primary objective is to determine if the use of patient-specific rehabilitation objectives derived from biomechanical analysis can lead to greater improvements in speed, economy, and safety relative to current approaches.

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