{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T16:45:39Z","timestamp":1786812339450,"version":"build-2736575974"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T00:00:00Z","timestamp":1646611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1105800"],"award-info":[{"award-number":["GNT1105800"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>Increased falls risk is prevalent among stroke survivors with gait impairments. Tripping is the leading cause of falls and it is highly associated with mid-swing Minimum Foot Clearance (MFC), when the foot\u2019s vertical margin from the walking surface is minimal. The current study investigated MFC characteristics of post-stroke individuals (<jats:italic>n<\/jats:italic>\u2009=\u200940) and healthy senior controls (<jats:italic>n<\/jats:italic>\u2009=\u200921) during preferred speed treadmill walking, using an Optotrak 3D motion capture system to record foot-ground clearance. In addition to MFC, bi-lateral spatio-temporal gait parameters, including step length, step width and double support time, were obtained for the post-stroke group\u2019s Unaffected and Affected limb and the control group\u2019s Dominant and Non-dominant limbs. Statistical analysis of MFC included central tendency (mean, median), step-to-step variability (standard deviation and interquartile range) and distribution (skewness and kurtosis). In addition, the first percentile, that is the lowest 1% of MFC values (MFC 1%) were computed to identify very high-risk foot trajectory control. Spatio-temporal parameters were described using the mean and standard deviation with a 2\u2009\u00d7\u20092 (Group\u2009\u00d7\u2009Limb) Multivariate Analysis of Variance applied to determine significant Group and Limb effects. Pearson\u2019s correlations were used to reveal any interdependence between gait variables and MFC control. The main finding of the current research was that post-stroke group\u2019s affected limb demonstrated lower MFC 1% with higher variability and lower kurtosis. Post-stroke gait was also characterised by shorter step length, larger step width and increased double support time. Gait retraining methods, such as using real-time biofeedback, would, therefore, be recommended for post-stroke individuals, allowing them to acquire optimum swing foot control and reduce their tripping risk by elevating the swing foot and improving step-to-step consistency in gait control.<\/jats:p>","DOI":"10.3389\/fphys.2022.833417","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T08:26:59Z","timestamp":1646641619000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors"],"prefix":"10.3389","volume":"13","author":[{"given":"Hanatsu","family":"Nagano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Sparrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rezaul","family":"Begg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,7]]},"reference":[{"key":"ref1","year":"2020"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.gaitpost.2008.10.061","article-title":"Variability in spatiotemporal step characteristics and its relationship to walking performance post-stroke","volume":"29","author":"Balasubramanian","year":"2009","journal-title":"Gait Posture"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.gaitpost.2010.07.010","article-title":"A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking","volume":"32","author":"Barrett","year":"2010","journal-title":"Gait Posture"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1111\/j.1747-4949.2012.00796.x","article-title":"Falls after stroke","volume":"7","author":"Batchelor","year":"2012","journal-title":"Int. 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Biomech."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1093\/ageing\/17.6.365","article-title":"Falls by elderly people at home prevalence and associated factors","volume":"17","author":"Blake","year":"1988","journal-title":"Age Ageing"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1093\/ptj\/82.11.1087","article-title":"Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury","volume":"82","author":"Blanton","year":"2002","journal-title":"Phys. Ther."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"283","DOI":"10.3389\/fneur.2019.00283","article-title":"Fear of falling contributing to cautious gait pattern in women exposed to a fictional disturbing factor: a non-randomized clinical trial","volume":"10","author":"Bueno","year":"2019","journal-title":"Front. Neurol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1093\/16erona\/glp184","article-title":"Sensorimotor factors affecting gait variability in older people\u2014a population-based study","volume":"65","author":"Callisaya","year":"2010","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.gaitpost.2006.03.003","article-title":"The influence of gait speed on local dynamic stability of walking","volume":"25","author":"England","year":"2006","journal-title":"Gait Posture"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1002\/mds.20507","article-title":"Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson\u2019s disease","volume":"20","author":"Frenkel-Toledo","year":"2005","journal-title":"Mov. Disord."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1038\/s41598-019-38723-3","article-title":"Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis","volume":"9","author":"Ghai","year":"2019","journal-title":"Sci. Rep."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.3389\/fphys.2018.01955","article-title":"Gait stability and its influencing factors in older adults","volume":"9","author":"Hamacher","year":"2019","journal-title":"Front. Physiol."},{"key":"ref001","first-page":"111","article-title":"Normative spatiotemporal gait parameters in older adults","volume-title":"Gait Posture","author":"Hollman","year":"2011"},{"key":"ref002","first-page":"358","article-title":"Motor system reorganization after stroke: stimulating and training toward perfection","volume-title":"Physiology","author":"Jones","year":"2015"},{"key":"ref17","article-title":"HAL: hybrid assistive limb based on cybernics","volume-title":"Robotics Research. 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Rehabil."},{"key":"ref003","first-page":"755","article-title":"The use of rhythmic auditory stimulation to optimize treadmill training for stroke patients: a randomized controlled trial","volume-title":"Front. Neurol.","author":"Mainka","year":"2018"},{"key":"ref21","first-page":"2037","article-title":"New therapeutic option for drop foot with the ActiGait peroneal nerve stimulator\u2014A technical note","volume-title":"World Neurosurg.","author":"Martin","year":"2015"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"8881","DOI":"10.3390\/app10248881","article-title":"Ageing-related gait adaptations to knee joint kinetics: implications for the development of knee osteoarthritis","volume":"10","author":"Nagano","year":"2020","journal-title":"Appl. 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Biomech."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"978","DOI":"10.3390\/brainsci10120978","article-title":"Feasibility of using foot\u2013ground clearance biofeedback training in treadmill walking for post-stroke gait rehabilitation","volume":"10","author":"Nagano","year":"2020","journal-title":"Brain Sci."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s12877-021-02117-w","article-title":"A cross-sectional study of foot-ground clearance in healthy community dwelling Japanese cohorts aged 50, 60 and 70 years","volume":"21","author":"Nagano","year":"2021","journal-title":"BMC Geriatr."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.gaitpost.2006.05.016","article-title":"Automatic detection of gait events using kinematic data","volume":"25","author":"O\u2019Connor","year":"2006","journal-title":"Gait Posture"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0212207","DOI":"10.1371\/journal.pone.0212207","article-title":"Dynamic stability and stepping strategies of young healthy adults walking on an oscillating treadmill","volume":"14","author":"Onushko","year":"2019","journal-title":"PLoS One"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"100156","DOI":"10.1016\/j.arrct.2021.100156","article-title":"Abnormal gait movements prior to a near fall in individuals after stroke","volume":"3","author":"Osada","year":"2021","journal-title":"Arch. 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Neurol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e0212646","DOI":"10.1371\/journal.pone.0212646","article-title":"Characteristics for gait parameters of community dwelling elderly Japanese with lower cognitive function","volume":"14","author":"Taniguchi","year":"2019","journal-title":"PLoS One"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1093\/ageing\/afs057","article-title":"Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators","volume":"41","author":"Taylor","year":"2012","journal-title":"Age Ageing"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.gaitpost.2012.06.034","article-title":"Older adults adopted more cautious gait patterns when walking in socks than barefoot","volume":"37","author":"Tsai","year":"2013","journal-title":"Gait Posture"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/MRR.0000000000000391","article-title":"Gait characteristics of post-stroke hemiparetic patients with different walking speeds","volume":"43","author":"Wang","year":"2019","journal-title":"Int. J. Rehabil. Res."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3389\/fphys.2018.00068","article-title":"Gait complexity and regularity are differently modulated by treadmill walking in Parkinson\u2019s disease and healthy population","volume":"9","author":"Warlop","year":"2018","journal-title":"Front. Physiol."},{"key":"ref41","volume-title":"The Biomechanics and Motor Control of Human Gait: Normal, Elderly and Pathological","author":"Winter","year":"1991"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.gaitpost.2012.02.020","article-title":"Voluntary changes in step width and step length during human walking affect dynamic margins of stability","volume":"36","author":"Young","year":"2012","journal-title":"Gait Posture"},{"key":"ref004","first-page":"1053","article-title":"Dynamic margins of stability during human walking in destabilizing environments","volume-title":"J. 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