Improved walking function in laboratory does not guarantee increased community walking in stroke survivors: Potential role of gait biomechanics

Abstract

Reduced daily stepping in stroke survivors may contribute to decreased functional capacity and increased mortality. We investigated the relationships between clinical and biomechanical walking measures that may contribute to changes in daily stepping activity following physical interventions provided to participants with subacute stroke. Following ≤40 rehabilitation sessions, 39 participants were categorized into three groups: responders/retainers increased daily stepping >500 steps/day post-training (POST) without decreases in stepping at 2-6 month follow-up (F/U); responders/non-retainers increased stepping at POST but declined >500 steps/day at F/U; and, non-responders did not change daily stepping from baseline testing (BSL). Gait kinematics and kinetics were evaluated during graded treadmill assessments at BSL and POST. Clinical measures of gait speed, timed walking distance, balance and balance confidence were measured at BSL, POST and F/U. Between-group comparisons and regression analyses were conducted to predict stepping activity from BSL and POST measurements. Baseline and changes in clinical measures of walking demonstrated selective associations with stepping, although kinematic measures appeared to better discriminate responders. Specific measures suggest greater paretic vs non-paretic kinematic changes in responders with training, although greater non-paretic changes predicted greater gains (i.e., smaller declines) in stepping in retainers at F/U. No kinetic variables were primary predictors of changes in stepping activity at POST or F/U. The combined findings indicate specific biomechanical assessments may help differentiate changes in daily stepping activity post-stroke.

Keywords: Gait kinematics; Stroke; Walking ability; Walking function.

Conflict of interest statement

Conflicts of interest statement

Authors do not have any conflict of interest to declare.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Figures

Fig. 1.

Single-participant example of hip (A), knee (B), and ankle (C) powers throughout the gait cycle at baseline (BSL; black) and post-training (POST; gray). Given the primary contributions of positive (i.e., concentric) joint powers to locomotor function, only average positive powers were used (shaded area). Data is identical to Fig. 1 in Ardestani et al., 2018 NNR.

Fig. 2.

Changes in paretic and non-paretic kinematics in responders (A) and non-responders (B) following rehabilitation interventions, and changes in paretic and non-paretic kinetics in responders/retainers (C) and responders/non-retainers (D).