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.
BackgroundAnkle–foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase.MethodsThis study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction.ResultsUsing AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs).ConclusionsSimplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings.Trial registrationUMIN000028946. Registered 31 August 2017 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0382-y) contains supplementary material, which is available to authorized users.
The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.
Toe clearance was mainly determined by limb shortening and hip elevation, which were found to be in a trade-off relationship. These results warrant further investigation into the use of three-dimensional motion analysis in the rehabilitation clinic to facilitate targeted rehabilitative training to restore gait ability.
The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.
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