Stability and Harmony of Gait in Patients with Subacute Stroke

Marco Iosa, Fabiano Bini, Franco Marinozzi, Augusto Fusco, Giovanni Morone, Giacomo Koch, Alex Martino Cinnera, Sonia Bonnì, Stefano Paolucci, Marco Iosa, Fabiano Bini, Franco Marinozzi, Augusto Fusco, Giovanni Morone, Giacomo Koch, Alex Martino Cinnera, Sonia Bonnì, Stefano Paolucci

Abstract

Stroke affects many gait features, such as gait stability, symmetry, and harmony. However, it is still unclear which of these features are directly altered by primary damage, and which are affected by the reduced walking speed. The aim of this study was to analyze the above gait features in patients with subacute stroke with respect to the values observed in age- and speed-matched healthy subjects. A wearable triaxial accelerometer and an optoelectronic device were used for assessing the upright gait stability, symmetry of trunk movements, and harmonic structure of gait phases by means of the root-mean-square (RMS) acceleration of the trunk, harmonic ratio (HR), and gait ratios (GRs), respectively. For healthy subjects, results showed that RMS acceleration increased with speed, HR peaked at a comfortable speed, and GRs tended towards the theoretical value of the golden ratio for speeds >1 m/s. At matched speed conditions, patients showed higher instabilities in the latero-lateral axis (p = 0.001) and reduced symmetry of trunk movements (p = 0.002). Different from healthy subjects, antero-posterior and latero-lateral acceleration harmonics were coupled in patients (R = 0.507, p = 0.023). Conversely, GRs were not more altered in patients than in slow-walking healthy subjects. In conclusion, patients with stroke showed some characteristics similar to those of the elderly when the latter subjects walk slowly, and some altered characteristics, such as increased latero-lateral instabilities coupled with movements performed along the antero-posterior axis.

Keywords: Accelerometry; Ambulation; Balance; Biomechanics; Golden ratio; Rehabilitation; Walking.

Conflict of interest statement

Compliance with Ethical Standards Conflict of interests The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Mean values of RMS acceleration for patients (filled circles) and healthy subjects (empty circles) and relevant quadratic fits (bold and thin lines, respectively) with coefficients of determination along cranio-caudal (CC, on left), latero-lateral (LL, in middle), and antero-posterior (AP, on right) body axes
Fig. 2
Fig. 2
Means and standard deviations (vertical bars) of harmonic ratio (HR) along cranio-caudal (CC, circles), latero-lateral (LL, squares), and antero-posterior (AP, diamonds) body axis for healthy adults (grey) and patients (black markers) reported with respect to the walking condition (slow, comfortable or fast). Walking speed standard deviations (horizontal bars) are reported only for CC data of both groups, being the same for the other two axes
Fig. 3
Fig. 3
Relative power of first 20 harmonics evaluated along three body axes for patients (black) and healthy subjects (grey) walking at similar speeds. Stars indicate statistically significant differences
Fig. 4
Fig. 4
Gait ratios (GR0: empty diamonds, GR1: filled circles, GR2: filled squares) for patients (black) and healthy adults (grey) with relevant exponential fits. Horizontal line represents theoretical golden gait ratio
Fig. 5
Fig. 5
Mean values of walking speed (WS), RMS acceleration, harmonic ratio (HR), and golden ratio (GR: cycles/stance) for patients (black line, circle markers) and healthy subjects walking at slow (light grey lines), comfortable (solid grey lines), and fast speeds (dotted grey lines)

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