Relationship between dynamic balance and spatiotemporal gait symmetry in hemiplegic patients with chronic stroke

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Abstract

Background:

Poor dynamic balance, which is common after stroke, may affect gait function. In particular, spatiotemporal asymmetrical gait patterns may occur in hemiplegic patients after stroke.

Objective:

This study aimed to assess the relationship between dynamic balance and spatiotemporal gait symmetry in patients with chronic hemiplegic stroke.

Methods:

To calculate symmetry ratios for step length (spatial parameter) and swing time (temporal parameter), 41 patients with chronic stroke walked at a comfortable speed. The dynamic balance measures included limit of stability (LOS) during standing and heel-to-heel base of support (H-H BOS) during gait. Analysis of correlations between various measures was performed.

Results:

The overall LOS score correlated with temporal gait symmetry ( r = 0.66). The forward, backward, paretic, and non-paretic direction LOS scores were related to temporal gait symmetry ( r = 0.38–0.62). The H-H BOS was correlated with temporal ( r = –0.63) and spatial ( r = –0.36) gait symmetries. Other dynamic balance variables were not significantly correlated with spatial gait symmetry.

Conclusion:

Thus, control of dynamic balance abilities is related to the magnitude of temporal gait symmetry. This observation suggests that rehabilitation strategies that improve dynamic balance may enhance temporal gait symmetry in post-stroke patients.

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Most cited references 21

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Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization.

Kara K. Patterson, William Gage, Dina Brooks … (2010)

Symmetry is a gait characteristic that is increasingly measured and reported, particularly in the stroke patient population. However, there is no accepted standard for assessing symmetry making it difficult to compare across studies and establish criteria to guide clinical decision making. This study compares the most common expressions of spatiotemporal gait symmetry to describe post-stroke gait and makes recommendations regarding the most suitable measure for standardization. The following symmetry equations were compared: symmetry ratio, symmetry index, gait asymmetry and symmetry angle using step length, swing time, stance time, double support time and an intra-limb ratio of swing: stance time. Comparisons were made within a group of 161 community-dwelling, ambulatory individuals with stroke and 81 healthy adults as a reference group. Our analysis supports the recommendations of the symmetry ratio as the equation for standardization and step length, swing time and stance time as the gait parameters to be used in the equation. Future work should focus on establishing the intra-individual variability of these measures and linking them to mechanisms of gait dysfunction. Copyright 2009 Elsevier B.V. All rights reserved.

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Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds.

Dhara H Kothari, George Chen, Carolynn Patten … (2005)

Treadmill walking was used to assess the consistent gait differences between six individuals with post-stroke hemiparesis and six non-disabled, healthy controls at matched speeds. The hemiparetic subjects walked on the treadmill at their comfortable speeds, while each control walked at the same speed as the hemiparetic subject with whom he or she was matched. Kinematic and insole pressure data were collected from multiple, steady-state gait cycles. A large set of gait differences found between hemiparetic and non-disabled subjects was consistent with impaired swing initiation in the paretic limb (i.e., inadequate propulsion of the leg during pre-swing, increased percentage swing time, and reduced knee flexion at toe-off and mid-swing in the paretic limb) and related compensatory strategies (i.e., pelvic hiking and swing-phase propulsion and circumduction of the paretic limb). Exaggerated positive work associated with raising the trunk during pre-swing and swing of the paretic limb, consistent with pelvic hiking, contributed to increased mechanical energetic cost during walking. A second set of gait differences found was consistent with impaired single limb support on the paretic limb (i.e., shortened support time on the paretic limb) and related compensatory strategies (i.e., exaggerated propulsion of the non-paretic limb during pre-swing to shorten its swing time). Other significant gait differences included asymmetry in step length and increased step width. We conclude that consistent gait differences exist between hemiparetic and non-disabled subjects walking at matched speeds. The differences provide insights, concerning hemiparetic impairment and related compensatory strategies, that are in addition to the observation of slow walking speed.

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Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.

Rong-Hwa Jan, Wei-Lun Hsu, Fang Tang (2003)

To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke. Descriptive analysis of convenience sample. Outpatient rehabilitation clinic of a hospital in Taiwan. Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device. Not applicable. Subjects' maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GaitMatII. Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R(2)=.57, R(2)=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R(2)=.76 for temporal asymmetry; R(2)=.46 for spatial asymmetry) and fast-speed (R(2)=.75 for temporal asymmetry; R(2)=.45 for spatial asymmetry) walking. Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments.

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Author and article information

Journal

Journal ID (nlm-ta): Hong Kong Physiother J

Journal ID (iso-abbrev): Hong Kong Physiother J

Journal ID (publisher-id): HKPJ

Title: Hong Kong Physiotherapy Journal

Publisher: Elsevier (Singapore) Pte Ltd

ISSN (Print): 1013-7025

ISSN (Electronic): 1876-441X

Publication date Collection: December 2017

Publication date (Electronic): 08 March 2017

Volume: 37

Pages: 19-24

Affiliations

[a ]Department of Physical Therapy, Chonbuk National University Hospital, Chonbuk, Republic of Korea

[b ]Department of Physical Therapy, Graduate School, Hanseo University, Republic of Korea

[c ]Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea

Author notes

[*] [* ]Corresponding author. Department of Physical Therapy, Chonbuk National University Hospital, Geonji-ro 21, Deokjin-gu, Jeonju-si, Chonbuk-do, 54907, Republic of Korea. E-mail address: dks3597@ 123456hanmail.net (C.-M. An).

Article

Publisher ID: 10.1016_j.hkpj.2017.01.002

DOI: 10.1016/j.hkpj.2017.01.002

PMC ID: 6385150

PubMed ID: 30931042

SO-VID: fd11e344-3dd4-4ec3-a790-de076fc39144

License:

This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

Relationship between dynamic balance and spatiotemporal gait symmetry in hemiplegic patients with chronic stroke

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Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

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Stroke MRI

Most cited references 21

Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization.

Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds.

Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.

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