A patient who had a brainstem stroke is able to walk 65 feet (20 m) with a straight cane and ascend stairs with minimum assistance. Which activity would most challenge the patient's balance?

A patient who had a brainstem stroke is able to walk 65 feet (20 m) with a straight cane and ascend stairs with minimum assistance. Which activity would most challenge the patient's balance?

• A. Ascending stairs using a single handrail
• B. Walking 130 ft (40 m) with a straight cane
• C. Walking over uneven terrain
• D. Standing on one leg with eyes closed

Answer: (C)

Dynamic balance on variable surfaces is most challenged because uneven terrain continually perturbs the center of mass, requiring rapid, coordinated adjustments from the hips, ankles, and trunk and seamless integration of sensory inputs. A brainstem stroke can disrupt automatic postural responses and vestibular processing, so tasks that demand quick, multi-joint corrections on an unpredictable surface are especially difficult. Walking farther with a cane on a flat surface relies on external support to reduce sway, and ascending stairs with a handrail provides a stable, guided pattern that lowers balance demands. Standing on one leg with eyes closed removes visual input but, if the surface is level, the body can still recruit static balance strategies. The unpredictable, changing surface of uneven terrain produces the greatest balance challenge for this patient.

Dynamic balance on variable surfaces is most challenged because uneven terrain continually perturbs the center of mass, requiring rapid, coordinated adjustments from the hips, ankles, and trunk and seamless integration of sensory inputs. A brainstem stroke can disrupt automatic postural responses and vestibular processing, so tasks that demand quick, multi-joint corrections on an unpredictable surface are especially difficult. Walking farther with a cane on a flat surface relies on external support to reduce sway, and ascending stairs with a handrail provides a stable, guided pattern that lowers balance demands. Standing on one leg with eyes closed removes visual input but, if the surface is level, the body can still recruit static balance strategies. The unpredictable, changing surface of uneven terrain produces the greatest balance challenge for this patient.