Evaluation of gait symmetry after stroke: A comparison of current methods and recommendations for standardization

Patterson, Kara K.; Gage, William H.; Brooks, Dina; Black, Sandra E.; McIlroy, William E.

doi:10.1016/j.gaitpost.2009.10.014

Cited by 546 publications

(491 citation statements)

References 20 publications

(30 reference statements)

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“…Our results of the gait symmetry evaluation are, however, at odds with the findings of Patterson et al, who reported a more asymmetric gait pattern in patients with stroke when compared with nondisabled individuals. In the current study, no significant asymmetry difference was found [40]. Nonetheless, the effect size for gait asymmetry exceeded the 0.3 level and showed, consequently, a medium effect.…”

Section: Wüest Et Al Sensor-based Itug Reliability and Validitycontrasting

confidence: 74%

“…For gait symmetry evaluation, various metrics can be considered. According to the literature, the most common symmetry metrics used for gait assessment are swing time, single support time, pelvic and/or trunk movement, and ground reaction forces [39][40]. Patterson et al concluded that the parameter "swing time" is suitable to analyze gait symmetry poststroke and, therefore, highly recommended [40].…”

Section: Wüest Et Al Sensor-based Itug Reliability and Validitymentioning

confidence: 99%

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Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

et al. 2016

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Abstract-The instrumented Timed " Up and Go" test (iTUG) has the potential for playing an important role in providing clinically useful information regarding an individual's balance and mobility that cannot be derived from the original singleoutcome Timed "Up and Go" test protocol. The purpose of this study was to determine the reliability and validity of the iTUG using body-fixed inertial sensors in people affected by stroke. For test-retest reliability analysis, 14 individuals with stroke and 25 nondisabled elderly patients were assessed. For validity analysis, an age-matched comparison of 12 patients with stroke and 12 nondisabled controls was performed. Out of the 14 computed iTUG metrics, the majority showed excellent testretest reliability expressed by high intraclass correlation coefficients (range 0.431-0.994) together with low standard error of measurement and smallest detectable difference values. BlandAltman plots demonstrated good agreement between two repeated measurements. Significant differences between patients with stroke and nondisabled controls were found in 9 of 14 iTUG parameters analyzed. Consequently, these results warrant the future application of the inertial sensor-based iTUG for the assessment of physical deficits poststroke in longitudinal study designs.

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Section: Wüest Et Al Sensor-based Itug Reliability and Validitycontrasting

confidence: 74%

Section: Wüest Et Al Sensor-based Itug Reliability and Validitymentioning

confidence: 99%

Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

et al. 2016

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“…Symmetry ratios were calculated by dividing the larger of the paretic or non-paretic value (step length or single support time) by the smaller; in accordance with recommendations [29]. Thus a value of 1 represents symmetrical gait and >1 is increasingly asymmetrical.…”

Section: Insert Figure 1: Methods Schematicmentioning

confidence: 99%

A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors

et al. 2016

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Background:Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. Methods:Stroke survivors (n=42) stepped to targets, on a 6m walkway, placed to elicit step lengthening, shortening and narrowing. The number of targets missed during six walks (3 targeting with paretic limb and 3 with non-paretic) and target stepping speed was recorded. Fugl-Meyer scores (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. Results:Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM(F(1,40)=6.54, p=0.014,). Speed of target stepping was a significant predictor of each of BBS(F(1,40)=26.36, p<0.0001), SSWS(F(1,40)=37.00, p<0.0001) and SS asymmetry (F(1,38)=5.57, p=.006). No variables were significant predictors of SL asymmetry. Discussion: Speed of target stepping was significantly predictive of SS symmetry, BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and temporal symmetry of gait and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors. Keywords: gait, adaptability, stroke, visionGait adaptability and functional mobility in stroke Background:

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“…Onset of GA can also follow acute events such as stroke [6] and amputation [7]. Thus, quantification of GA has become central to the clinical monitoring and treatment of many chronic and acute neurological and musculoskeletal diseases [8][9].…”

Section: -Introductionmentioning

confidence: 99%

“…Gait asymmetry is typically evaluated using kinematic data and spatio-temporal gait parameters (step/ stride length and duration). Based on these global variables, indicators have been introduced to quantify asymmetry, including the Symmetry Ratio [6] and Symmetry Index [6]. These indicators provide global asymmetry information for a studied gait cycle, but cannot be used to analyse how asymmetry occurs at specific instances within the gait cycle.…”

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confidence: 99%

Validity and sensitivity of the longitudinal asymmetry index to detect gait asymmetry using Microsoft Kinect data

et al. 2017

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Research highlights:-The Continuous Relative Phase is not useable with Kinect.-New longitudinal index Ilong is sensitive and validated to detect gait asymmetry.-The Ilong index works with Kinect placed either in front of or behind subjects.-Only few strides (at least 5) are needed to compute a valid Ilong. AbstractGait asymmetry information is a key point in disease screening and follow-up. Constant Relative Phase (CRP) has been used to quantify within-stride asymmetry index, which requires noise-free and accurate motion capture, which is difficult to obtain in clinical settings. This study explores a new index, the Longitudinal Asymmetry Index (ILong) which is derived using data from a low-cost depth camera (Kinect). ILong is based on depth images averaged over several gait cycles, rather than derived joint positions or angles. This study aims to evaluate 1) the validity of CRP computed with Kinect, 2) the validity and sensitivity of ILong for measuring gait asymmetry based solely on data provided by a depth camera, 3) the clinical applicability of a posteriorly mounted camera system to avoid occlusion caused by the standard front-fitted treadmill consoles and 4) the number of strides needed to reliably calculate ILong. The gait of 15 subjects was recorded concurrently with a markerbased system (MBS) and Kinect, and asymmetry was artificially reproduced by introducing a 5cm sole attached to one foot. CRP computed with Kinect was not reliable. ILong detected this disturbed gait reliably and could be computed from a posteriorly placed Kinect without loss of validity. A minimum of five strides was needed to achieve a correlation coefficient of 0.9 between standard MBS and low-cost depth camera based ILong. ILong provides a clinically pragmatic method for measuring gait asymmetry, with application for improved patient care through enhanced disease, screening, diagnosis and monitoring.Keywords: Kinect; Gait analysis; gait asymmetry; sensitivity analysis; CRP. Gait asymmetry is typically evaluated using kinematic data and spatio-temporal gait parameters (step/ stride length and duration). Based on these global variables, indicators have been introduced to quantify asymmetry, including the Symmetry Ratio [6] and Symmetry Index [6]. These indicators provide global asymmetry information for a studied gait cycle, but cannot be used to analyse how asymmetry occurs at specific instances within the gait cycle.To overcome this limitation, some authors have proposed analysis of the Constant Relative Phase (CRP) and its derivatives [10]. For a given joint, this indicator constructs a phase diagram based on angular value and angular velocity. Gait asymmetry can be assessed by comparing the CRP of the corresponding left and right joints. It has been used to measure asymmetry caused by weights placed on one foot [11] and pathologies such as stroke [12].However, CRP is based on sagittal joint angles and their derivatives, which impose the use of accurate and noise-free motion capture systems, such as optoelectronic systems [11,12]...

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Evaluation of gait symmetry after stroke: A comparison of current methods and recommendations for standardization

Cited by 546 publications

References 20 publications

Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors

Validity and sensitivity of the longitudinal asymmetry index to detect gait asymmetry using Microsoft Kinect data

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