Gait Disturbances in Patients With Stroke

Balaban, Birol; Tok, Fatih

doi:10.1016/j.pmrj.2013.12.017

Cited by 297 publications

(258 citation statements)

References 46 publications

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“…Gait is an activity that requires adequate MC of the lower limbs, since the intensity and duration of muscular activity are continuously and selectively modulated (28). Thus, as an instrument that evaluates MC, it was expected that the LEMOCOT scores could discriminate between individuals with various functional levels.…”

Section: Discussionmentioning

confidence: 99%

Measurement properties of the lower extremity motor coordination test in individuals with stroke

Kk¹,

Aa²,

Faria‐Fortini³

et al. 2015

J Rehabil Med

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Objectives: To evaluate the construct validity, inter-and intra-rater reliabilities, best scoring method and testing methods (direct vs video observations), and to determine the smallest real difference (SRD) and standard error of the measurement (SEM) of the Lower Extremity Motor Coordination Test (LEMOCOT). Design: Methodological study. Subjects: Thirty-six stroke subjects. Methods: Outcomes include measures of motor recovery, muscular tone, strength, motor coordination, foot tactile sensation, and gait speed. Results: The LEMOCOT scores were able to discriminate between stroke individuals from those predicted for healthy subjects, between the paretic and non-paretic limbs for both the sub-acute and chronic groups and differentiated between individuals with different functional levels and degrees of motor recovery. For the intra-and inter-rater reliabilities, very high and significant coefficients were found for both the paretic and non-paretic lower limbs for both groups (intraclass correlation coefficients (ICC) > 0.97, p < 0.0001). Significant differences were found regarding all scoring methods (18.91 < F < 27.49, p < 0.0001), but they were not clinically important and all showed adequate test-retest reliability and acceptable SRD and SEM (< 15%) values. There was also agreement between the scores from the direct and video observations. Conclusion: The LEMOCOT demonstrated adequate measurement properties in stroke subjects and, therefore, could be an appropriate measure for research and clinical purposes.

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Section: Discussionmentioning

confidence: 99%

Measurement properties of the lower extremity motor coordination test in individuals with stroke

Kk¹,

Aa²,

Faria‐Fortini³

et al. 2015

J Rehabil Med

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“…Knowing that sensorimotor impairments vary substantially among individuals post stroke, it is expected that large variability will also exist in their level of gait asymmetry. For detailed descriptive reports of asymmetries of spatiotemporal, kinematic, and kinetic gait parameters in individuals with stroke, the readers are invited to consult previous papers [34][35][36].…”

Section: Gait Asymmetry In Individuals Post Strokementioning

confidence: 99%

“…Following a stroke, it has been shown that many biomechanical parameters are asymmetrical [34][35][36]60]. Figure 2 presents the anteroposterior and vertical components of the ground reaction forces (GRF) during self-selected gait in healthy individuals (n=14) and individuals post stroke (n=35) on both sides (paretic and non-paretic).…”

Section: Biomechanical Impairments Underlying Spatiotemporal Asymmetrmentioning

confidence: 99%

“…Figure 2 presents the anteroposterior and vertical components of the ground reaction forces (GRF) during self-selected gait in healthy individuals (n=14) and individuals post stroke (n=35) on both sides (paretic and non-paretic). Detailed descriptions of biomechanical modifications in individuals post stroke of joint angles, net joint moments and net joint powers have already been reported [34][35][36]60]. However, to date, few studies have considered regrouping the participants according to the direction of the spatial and temporal asymmetries to explain the role of biomechanical parameters in gait asymmetry.…”

Section: Biomechanical Impairments Underlying Spatiotemporal Asymmetrmentioning

confidence: 99%

“…For example, a lack of hip flexion moment (eccentric action) from middle to late stance on the paretic side seen with reduced thigh movement in extension could prevent normal nonparetic swing and resulted in a shorter non-paretic swing time ( Figure 3) [34,66]. Indeed, many studies have observed a reduced hip flexor moment associated with a reduced hip negative power burst (H2) from mid-stance to late stance of the gait cycle in stroke [34,36].…”

Section: Biomechanical Impairments Underlying Temporal Asymmetrymentioning

confidence: 99%

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Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

Lauzière¹,

Betschart²,

Aïssaoui³

et al. 2014

Int J Phys Med Rehabil

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Gait asymmetry in spatial and temporal parameters and its impacts on functional activities have always raised many interesting questions in research and rehabilitation. The aim of this topical review is threefold: 1) to examine different equations of asymmetry of gait parameters and make recommendations for standardization, 2) to deepen the understanding of the relationships between sensorimotor deficits, spatiotemporal (step length, swing time and double support time) and biomechanical (kinematic, kinetic, muscular activity) parameter asymmetries during gait and, 3) to summarize the impacts of gait asymmetry on walking speed, falls, and energy cost in individuals post stroke. In light of current literature, we recommend quantifying spatiotemporal asymmetries by calculating symmetry ratios. However, for other gait parameters (such as kinetic or kinematic data), the choice will depend on the variability of the data and the objective of the study. Regardless of the selected asymmetry equation, we recommend presenting the asymmetry values in combination with the mean value of each side to facilitate comparisons between studies. This review also revealed that sensorimotor deficits clinically measured are not sufficient to explain the large variability of spatiotemporal asymmetries (particularly for step length and double support time) in individuals post stroke. Biomechanical analysis has been identified as a relevant approach to understanding gait deviations. Studies that linked biomechanical impairments to spatiotemporal asymmetries suggest that a balance issue and an impaired paretic forward propulsion could be among the important factors underlying spatiotemporal asymmetries. In our opinion, this paper provides meaningful information to aid in better understanding gait deviations in persons after stroke and establishes the need for future studies regrouping individuals post stroke according to their spatiotemporal asymmetries. Furthermore, further studies targeting efficacy of locomotor rehabilitation and the impacts of gait asymmetry on risk of falls and energy expenditure are needed.

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Activity Monitor Placed at the Nonparetic Ankle Is Accurate in Measuring Step Counts During Community Walking in Poststroke Individuals: A Validation Study

Duclos

Aguiar

Aïssaoui

et al. 2019

PM&R

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Background Different environmental factors may affect the accuracy of step‐count activity monitors (AM). However, the validation conditions for AM accuracy largely differ from ecological environments. Objectives To assess and compare the accuracy of AM in counting steps among poststroke individuals: during different locomotor tasks, with AM placed at the nonparetic ankle or hip, and when walking in a laboratory or inside a mall. Design Validation study. Settings Laboratory and community settings. Participants Twenty persons with chronic hemiparesis, independent walkers. Methods First session: participants performed level walking (6‐minute walk test [6MWT]), ramps, and stairs in the laboratory with AM placed at the nonparetic ankle and hip. Second session: participants walked a mall circuit, including the three tasks, with AM placed at the nonparetic ankle. The sessions were video recorded. Main Outcome Measurements Absolute difference between the steps counted by AM and the steps viewed on the video recordings (errors, %); occurrence of errors greater than 10%. Results Median errors were similar for the 6MWT (0.86 [0.22, 7.70]%), ramps (2.17 [0.89, 9.61]%), and stairs (8.33 [2.65, 19.22]%) with AM at the ankle. Step‐count error was lower when AM was placed at the ankle (8.33 [2.65, 19.22]%) than at the hip (9.26 [3.25, 42.63]%, P = .03). The greatest errors were observed among the slowest participants (≤0.4 m/s) on ramps and stairs, whereas some faster participants (>1 m/s) experienced the greatest error during the 6MWT. Median error was slightly increased in the mall circuit (2.67 [0.61, 12.54]%) compared with the 6MWT (0.50 [0.24, 6.79]%, P = .04), with more participants showing errors >10% during the circuit (7 vs 2, P = .05). Conclusions Step counts are accurately measured with AM placed at the nonparetic ankle in laboratory and community settings. Accuracy can be altered by stairs and ramps among the slowest walkers and by prolonged walking tasks among faster walkers. Level of Evidence III.

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Gait Disturbances in Patients With Stroke

Cited by 297 publications

References 46 publications

Measurement properties of the lower extremity motor coordination test in individuals with stroke

Measurement properties of the lower extremity motor coordination test in individuals with stroke

Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

Activity Monitor Placed at the Nonparetic Ankle Is Accurate in Measuring Step Counts During Community Walking in Poststroke Individuals: A Validation Study

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