A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Abstract

Background In walking rehabilitation trials, self-selected walking speed has emerged as the dominant outcome measure to assess walking ability. However, this measure cannot differentiate between recovery of impaired movement and compensation strategies. Spatiotemporal variables and asymmetry ratios are frequently used to quantify gait deviations and are hypothesized markers of recovery. Objectives The purpose of this review is to investigate spatiotemporal variables and asymmetry ratios as mechanistic recovery measures in physical therapy intervention studies post-stroke. Methods A systematic literature search was performed to identify physical therapy intervention studies with a statistically significant change in self-selected walking speed post intervention and concurrently collected spatiotemporal variables. Methodological quality was assessed using the Cochrane Collaboration’s tool. Walking speed, spatiotemporal, and intervention data were extracted. Results 46 studies met the inclusion criteria, 41 of which reported raw spatiotemporal measures and 19 reported asymmetry ratio calculations. Study interventions included: aerobic training (n=2), functional electrical stimulation (n=5), hippotherapy (n=2), motor dual task training (n=2), multidimensional rehabilitation (n=4), robotics (n=4), sensory stimulation training (n=8), strength/resistance training (n=4), task specific locomotor rehabilitation (n=9), and visually guided training (n=6). Conclusions Spatiotemporal variables help describe gait deviations, but scale to speed, so consequently, may not be an independent factor in describing functional recovery and gains. Therefore, these variables are limited in explaining mechanistic changes involved in improving gait speed. Use of asymmetry measures provides additional information regarding the coordinative requirements for gait and can potentially indicate recovery. Additional laboratory-based mechanistic measures may be required to truly understand how walking speed improves.

An umbrella review of the evidence for equine‐assisted interventions

“…Three systematic reviews (Stergiou et al, ; White‐Lewis et al, ; Wonsetler & Bowden, ) examined the effect of hippotherapy or THR on adults following stroke, however, this constituted only three unique studies. Motor impairment in the lower limbs (Stergiou et al, ; White‐Lewis et al, ), gait velocity (White‐Lewis et al, ), step length asymmetry (White‐Lewis et al, ; Wonsetler & Bowden, ), and quality of life (White‐Lewis et al, ) demonstrated statistically significant improvements while balance (White‐Lewis et al, ), ambulation (White‐Lewis et al, ), and cadence did not (White‐Lewis et al, ).…”

The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial

“…Variability was expressed by standard deviation/mean ×100% to indicate the consistency of gait Scientific RepoRtS | (2020) 10:1201 | https://doi.org/10.1038/s41598-020-58098-0 www.nature.com/scientificreports www.nature.com/scientificreports/ pattern 44 . Asymmetry ratio was quantified by the percentage as follows: paretic side/non-paretic side ×100%, with step length indicating for spatial parameters and step time for temporal 45 . The averaged value of 3 trials were used for data analysis.…”

Effectiveness of Circuit‐Based Exercises on Gait Speed, Balance, and Functional Mobility in People Affected by Stroke: A Meta‐Analysis

“…This was clearly demonstrated by another systematic review that assessed the effectiveness of cardiovascular conditioning on comfortable gait speed. This meta‐analysis showed a small increase of 0.08 m/s, but the average gait speed at the end was 0.72 m/s, which was responsible for the improvement of walking speed from moderate to mild [27]. Moreover, changes ranged from 0.10 to 0.20 m/s were demonstrated to be minimal clinically important for difference in comfortable gait speed across multiple patients with disease [30].…”