Subtasks affecting step-length asymmetry in post-stroke hemiparetic walking

Change in Center of Pressure Progression in the Foot Provides Clues for Functional Improvement of the More Affected Lower Limb During Post-stroke Gait Rehabilitation

OBJECTIVE

The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (apCoP) in post-stroke gait rehabilitation.

DESIGN

This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The apCoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between apCoP changes and spatiotemporal parameter changes were investigated.

RESULTS

The apCoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the apCoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the apCoP on the more affected side.

CONCLUSION

The change in apCoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The apCoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation.

Asymmetry and Variability Should Be Included in the Assessment of Gait Function in Poststroke Hemiplegia With Independent Ambulation During Early Rehabilitation

OBJECTIVE

To extract independent features from spatiotemporal data of poststroke gait.

DESIGN

Retrospective observational study.

SETTING

Motion analysis laboratory in the rehabilitation department of a university hospital.

PARTICIPANTS

Convenience sample from inpatients in subacute recovery stage post stroke. Of 98 patients post stroke who underwent gait assessment, 69 patients post stroke were included in the data analysis (N=69). They could walk more than 10 m without personal assist or assistive devices.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Spatiotemporal parameters during level walking and their asymmetry and variability were obtained by insole foot pressure measurement system.

RESULTS

Of independent components extracted by principal component analysis, 3 independent components explained 81.9% of total variance of spatiotemporal poststroke gait data. The first component has associations with walking speed and proportion of double support phase, and it explains 46.6% of total variance. The second component has association with temporal asymmetry, and it explains 21.1% of total variance. The third component has association with temporal variability, and it explains 14.2% of total variance. Principal component scores did not show significant differences between stroke types and among stroke lesions.

CONCLUSIONS

Temporal asymmetry and variability should be included in the assessment of poststroke gait during early rehabilitation. They are independent of each other and provide characteristics of poststroke gait that are independent to the walking speed. They are helpful for rehabilitation planning and developing treatment strategy in poststroke gait rehabilitation.