Perturbation Training in Stroke Rehabilitation

Community-dwelling stroke survivors are at high-risk of falls, with 5 times at greater risk of falls than their healthy counterparts due to significant balance impairments, decreased functional mobility, and declines in cognitive function. Post stroke, not only physical impairments but attentional resources and cognitive decline also contribute to fall risk. Dual task related interventions in virtual reality environments with the opportunity to recruit intentional and reactive balance mechanisms through perturbations during walking, are needed to reduce fall risk and improve physical activity in this population. Based on this conceptual framework, this study aims is to examine efficacy of GRAIL based perturbation training in older chronic stroke survivors on fall-risk reduction. This intervention combines virtual reality and cognitive training to address the need for significant gains in balance control that are required to meet the physical and attentional demands for independent functional mobility in stroke rehabilitation.