Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study

Abstract

BackgroundMultiple aspects of gait are typically impaired post-stroke. Asymmetric gait is common as a consequence of unilateral brain lesions. The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear. The objective of this exploratory study is to quantify the effects of hemiparesis on two putatively independent aspects of the bilateral coordination of gait to gain insight into mechanisms and their relationship and to assess their potential as clinical markers.MethodsTwelve ambulatory stroke patients and age-matched healthy adults wore a tri-axial piezo-resistive accelerometer and walked back and forth along a straight path in a hall at a comfortable walking speed during 2 minutes. Gait speed, gait asymmetry (GA), and aspects of the bilateral coordination of gait (BCG) were determined. Bilateral coordination measures included the left-right stepping phase for each stride φi, consistency in the phase generation φ_CV, accuracy in the phase generation φ_ABS, and Phase Coordination Index (PCI), a combination of accuracy and consistency of the phase generation.ResultsGroup differences (p < 0.001) were observed for gait speed (1.1 ± 0.1 versus 1.7 ± 0.1 m/sec for patients and controls, respectively), GA (26.3 ± 5.6 versus 5.5 ± 1.2, correspondingly) and PCI (19.5 ± 2.3 versus 6.2 ± 1.0, correspondingly). A significant correlation between GA and PCI was seen in the stroke patients (r = 0.94; p < 0.001), but not in the controls.ConclusionsIn ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired. Although these features are not related to each other in healthy controls, they are strongly related in stroke patients, which is a novel finding. A measurement approach based on body-fixed sensors apparently may provide sensitive markers that can be used for clinical assessment and for enhancing rehabilitation targeting in post-stroke patients.

Estimation of Gait Independence Using a Tri-Axial Accelerometer in Stroke Patients

“…"Estimation of Gait Independence Using a Tri-Axial Accelerometer in Stroke Patients" by Kijima Y et al Journal of Aging and Physical Activity © 2017 Human Kinetics, Inc. Stroke patients walked more slowly than the control group, and the dependent group walked significantly more slowly than independent group; these results were consistent with a previous report (Meijer et al, 2011). A study has suggested the importance of gait velocity to assess the gait ability in stroke patients (Schmid et al, 2007), and gait velocity has a large influence on acceleration (Henriksen et al, 2004).…”

“…Gait regularity in all directions of the trunk and unaffected thigh and in the VT direction of the affected thigh was decreased in the dependent group compared with the independent and control groups, consistent with previous studies (Meijer et al, 2011;Mizuike et al, 2009). In comparisons excluding the effect of gait velocity, gait symmetry, calculated from an acceleration in AP and VT directions of the trunk and in the VT direction of the thigh, was decreased in the dependent group compared with the independent and control groups.…”

Impact of stroke on anterior–posterior force generation prior to seat-off during sit-to-walk

“…This preference for the non-paretic limb is also reported during other daily transfers, such as sit-to-stand and stand-to-sit [12], and during gait initiation from standing [21]. Similar interlimb dys-coordination, as in the present study, has been demonstrated during walking post-stroke as impaired leftright stepping coordination [22], and impaired processing of afferent input between the two body sides [23]. These atypical characteristics of gait post-stroke are suggested to be distinct properties that should be targeted in rehabilitation [22,23].…”

Aerobic, Resistance, and Cognitive Exercise Training Poststroke

“…3 As a result, gait patterns become asymmetrical and gait speed reduced. 4 Additionally, impaired walking is commonly observed beyond 6 months after stroke. 5 This lack of walking competency can precipitate and exacerbate a sedentary lifestyle and cardiovascular deconditioning.…”