Stroke is a complex neurological problem with numerous negative impacts on both cognitive and physical functions. One of the most prominent physical impairments occurs to gait, leading to risk of falls due to loss of postural control. Falls in stroke survivors is complex and depends on the interrelationship between individual, environment and the nature of the task. The aims of this study were to examine the effect of walking task constraint on dynamic stability and the association between dynamic stability and walking ability and balance in people with stroke.

Ten hemiplegic stroke survivors (6 males and 4 females) voluntarily took part in this study and walked on a treadmill at their preferred speed under 2 different conditions: level walking and uphill walking (5° slope). A motion analysis system was used to assess gait performance in initial contact and toe-off moments. The primary outcomes of this study were margin of stability, balance (TUG test) and walking ability (10MWT and treadmill speed).

The results of this study showed that uphill walking had greater stability in initial contact in anterior-posterior direction (t=−2.49, P<0.05, ES=0.43), whereas level walking showed greater stability in toe-off in mediolateral direction (t=2.31, P<0.05, ES=1.5). In addition, dynamic stability showed strong associations with walking ability (r=0.82, P<0.05) and balance (r=0.92, P<0.05) in the uphill walking condition.

Walking in a challenging condition, like uphill, requires adjustments in dynamic gait stability in stroke survivors that is predicted by adaptations in walking performance.