Gait characteristics of post-stroke hemiparetic patients with different walking speeds

Yiji Wang, Masahiko Mukaino, Kei Ohtsuka, Yohei Otaka, Hiroki Tanikawa, Fumihiro Matsuda, Kazuhiro Tsuchiyama, Junya Yamada, Eiichi Saitoh, Yiji Wang, Masahiko Mukaino, Kei Ohtsuka, Yohei Otaka, Hiroki Tanikawa, Fumihiro Matsuda, Kazuhiro Tsuchiyama, Junya Yamada, Eiichi Saitoh

Abstract

Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (<3.4 km/h). High RSIs of stance and swing times were also observed (-9.62 ± 10.32 vs. -0.79 ± 2.93, 24.24 ± 25.75 vs. 1.76 ± 6.43, respectively). High ASIs and CVs were more generally observed, including the groups with gait speed of ≥3.5 km/h. ASI increase of the swing phase (25.79 ± 22.69 vs. 4.83 ± 4.88) and CV of the step length [7.7 ± 4.9 (paretic)/7.6 ± 5.0 (nonparetic) vs. 5.3 ± 3.0] were observed in all gait speed groups. Our data suggest that abnormalities in the spatiotemporal parameters of hemiparetic gait should be interpreted in relation to gait speed. ASIs and CVs could be highly sensitive indices for detecting gait abnormalities.

Figures

Fig. 1
Fig. 1
Flow diagram for data extraction and matching.

References

    1. Abe H, Michimata A, Sugawara K, Sugaya N, Izumi S. Improving gait stability in stroke hemiplegic patients with a plastic ankle-foot orthosis. Tohoku J Exp Med. 2009; 218:193–199
    1. Allen JL, Kautz SA, Neptune RR. Step length asymmetry is representative of compensatory mechanisms used in post-stroke hemiparetic walking. Gait Posture. 2011; 33:538–543
    1. Balaban B, Tok F. Gait disturbances in patients with stroke. PM R. 2014; 6:635–642
    1. Balasubramanian CK, Bowden MG, Neptune RR, Kautz SA. Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil. 2007; 88:43–49
    1. Brach JS, Studenski S, Perera S, VanSwearingen JM, Newman AB. Stance time and step width variability have unique contributing impairments in older persons. Gait Posture. 2008; 27:431–439
    1. Brandstater ME, de Bruin H, Gowland C, Clark BM. Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil. 1983; 64:583–587
    1. Chen G, Patten C, Kothari DH, Zajac FE. Gait deviations associated with post-stroke hemiparesis: improvement during treadmill walking using weight support, speed, support stiffness, and handrail hold. Gait Posture. 2005a; 22:57–62
    1. Chen G, Patten C, Kothari DH, Zajac FE. Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait Posture. 2005b; 22:51–56
    1. Chino N, Sonoda S, Domen K, Saitoh E, Kimura A. Stroke Impairment Assessment Set (SIAS). A new evaluation instrument for stroke patients. Jpn J Rehabil Med. 1994; 31:119–125
    1. Hausdorff JM, Nelson ME, Kaliton D, Layne JE, Bernstein MJ, Nuernberger A, Singh MA. Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise. J Appl Physiol (1985). 2001a; 90:2117–2129
    1. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001b; 82:1050–1056
    1. Hendrickson J, Patterson KK, Inness EL, McIlroy WE, Mansfield A. Relationship between asymmetry of quiet standing balance control and walking post-stroke. Gait Posture. 2014; 39:177–181
    1. Hishikawa N, Tanikawa H, Ohtsuka K, Mukaino M, Inagaki K, Matsuda F, et al. Quantitative assessment of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip in hemiplegia using three-dimensional treadmill gait analysis. Top Stroke Rehabil. 2018; 25:548–553
    1. IJmker T, Lamoth C J, Houdijk H, Tolsma M, van der Woude LH, Daffertshofer A, Beek PJ. Effects of handrail hold and light touch on energetics, step parameters, and neuromuscular activity during walking after stroke. J Neuroeng Rehabil. 2015; 12:70.
    1. Itoh N, Kagaya H, Saitoh E, Ohtsuka K, Yamada J, Tanikawa H, et al. Quantitative assessment of circumduction, hip hiking, and forefoot contact gait using Lissajous figures. Jpn J Compr Rehabil Sci. 2012; 3:78–84
    1. Kang HG, Dingwell JB. Separating the effects of age and walking speed on gait variability. Gait Posture. 2008; 27:572–577
    1. Kressig RW, Herrmann FR, Grandjean R, Michel JP, Beauchet O. Gait variability while dual-tasking: fall predictor in older inpatients?. Aging Clin Exp Res. 2008; 20:123–130
    1. Lamoth CJ, van Deudekom FJ, van Campen JP, Appels BA, de Vries OJ, Pijnappels M. Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people. J Neuroeng Rehabil. 2011; 8:2.
    1. Lauziere S, Betschart M, Aissaoui R, Nadeau S. Understanding spatial and temporal gait asymmetries in individuals post stroke. Int J Phys Med Rehabil. 2014; 2:201
    1. Lewek MD, Bradley CE, Wutzke CJ, Zinder SM. The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke. J Appl Biomech. 2014; 30:31–36
    1. Maki BE. Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc. 1997; 45:313–320
    1. Mukaino M, Ohtsuka K, Tanikawa H, Matsuda F, Yamada J, Itoh N, et al. Clinical-oriented three-dimensional gait analysis method for evaluating gait disorder. J Vis Exp. 2018; 133:57063
    1. Mukaino M, Ohtsuka K, Tsuchiyama K, Matsuda F, Inagaki K, Yamada J, et al. Feasibility of a simplified, clinically oriented, three-dimensional gait analysis system for the gait evaluation of stroke patients. Prog Rehabil Med. 2016; 1:20160001
    1. Nadeau S, Arsenault AB, Gravel D, Bourbonnais D. Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil. 1999; 78:123–130
    1. Nadeau S, Betschart M, Bethoux F. Gait analysis for poststroke rehabilitation: the relevance of biomechanical analysis and the impact of gait speed. Phys Med Rehabil Clin N Am. 2013; 24:265–276
    1. Parker K, Hanada E, Adderson J. Gait variability and regularity of people with transtibial amputations. Gait Posture. 2013; 37:269–273
    1. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Changes in gait symmetry and velocity after stroke: a cross-sectional study from weeks to years after stroke. Neurorehabil Neural Repair. 2010; 24:783–790
    1. Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008; 89:304–310
    1. Rinaldi LA, Monaco V. Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed. J Neuroeng Rehabil. 2013; 10:53.
    1. Robinson RO, Herzog W, Nigg BM. Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry. J Manipulative Physiol Ther. 1987; 10:172–176
    1. Roerdink M, Beek PJ. Understanding inconsistent step-length asymmetries across hemiplegic stroke patients: impairments and compensatory gait. Neurorehabil Neural Repair. 2011; 25:253–258
    1. Roth EJ, Merbitz C, Mroczek K, Dugan SA, Suh WW. Hemiplegic gait. Relationships between walking speed and other temporal parameters. Am J Phys Med Rehabil. 1997; 76:128–133
    1. Tanikawa H, Ohtsuka K, Mukaino M, Inagaki K, Matsuda F, Teranishi T, et al. Quantitative assessment of retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis. Top Stroke Rehabil. 2016; 23:311–317
    1. Titianova EB, Peurala SH, Pitkänen K, Tarkka IM. Gait reveals bilateral adaptation of motor control in patients with chronic unilateral stroke. Aging Clin Exp Res. 2008; 20:131–138
    1. Titianova EB, Tarkka IM. Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. J Rehabil Res Dev. 1995; 32:236–244
    1. Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci. 2009; 64:896–901
    1. Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios. Top Stroke Rehabil. 2017; 24:435–446

Source: PubMed

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