Relationship between the rate of perceived stability, electrodermal activity and task performance during balance challenges in chronic stroke

IntroductionIn addition to sensorimotor impairments following stroke, decreased self-efficacy regarding walking balance may lead to self-imposed limitations on community level mobility, especially among women. The Rate of Perceived Stability (RPS) is a self-efficacy measure used to assess individual perception of balance ability when standing or walking balance is challenged. Measurement of electrodermal activation (EDA), modulated by the autonomic nervous system, during perturbations to standing balance reflects the physiological arousal ( fight or flight) response of the individual as they maintain or recover their balance. This study aims to examine the relationships between EDA, task performance ability, and RPS in individuals with chronic stroke performing balance challenges. Further, the study explores how sex and repeat exposure moderate these relationships. MethodsOver two testing days, participants with chronic stroke (>1 year) were assessed on walking balance task performance with the Community Balance and Mobility Scale (CB&M) and rated their perceived stability using the RPS. EDA measured the physiological arousal during task performance. Linear mixed models were used to assess: 1) the relationship between CB&M task performance and RPS and whether sex or repeat exposure moderates this relationship, 2) the relationship between the physiological arousal response and RPS and whether sex or repeat exposure moderates this relationship, and 3) whether physiological arousal response mediates the relationship between CB&M task performance and RPS. ResultsThirty individuals with chronic stroke, with moderate severity lower extremity impairment (Chedoke McMaster Stroke Assessment score 4-5/7) participated in the study, including 15 males (mean age: 65.1 {+/-} 10.2 years; time since stroke: 9.4 {+/-} 4.7 years) and 15 females (mean age: 65.5 {+/-} 9.7 years; time since stroke: 7.6 {+/-} 5.9 years). Increase in walking balance task performance, CB&M scores, were associated with decreases in participant RPS scores relative of 2.80 (95% CI [-3.29 - -2.30]) to 3.87 (95% CI [-4.32 - -3.02]) points, explaining 20.4% of the variability in the RPS. Physiological arousal significantly predicted RPS scores explaining 1.8% of the variability in the RPS. Repeat exposure and sex did not moderate the relationships between the predictors (physiological arousal and task performance) and RPS. Physiological arousal was not found to be a significant mediator of the relationship between the CB&M task performance scores and RPS. All models showed that accounting for participant-specific random effects explained more variance in RPS than physiological arousal and task performance. ConclusionAbility to perform a walking balance task (CB&M task performance score) and the underlying physiological arousal response (EDA) are independent predictors of perception of balance in people with chronic stroke as measured by the RPS. However, individual characteristics not captured in this study account for a greater proportion of the variability of the self-reported perception of balance during tasks performed. Potential characteristics may include constructs such as fall history and level of physical activity highlighting the complexity of perception of balance ability post-stroke.