Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke

Abstract

We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.

Patterns of change in propulsion force and late braking force in patients with stroke walking at fast speeds

“…Calculated spatiotemporal gait metrics included walking velocity, step length for the paretic limb, step length for the non-paretic limb, and the maximum knee exion angles of the paretic limb during the preswing and swing phases. Additionally, pelvic hike and hip circumduction, common gait deviations observed in stroke patients 14,16,[29][30][31] , were assessed. Pelvic hike was determined from the pelvic angle, while the maximum hip circumduction was derived from the hip abduction angle.…”

Assessment of Agreement Between a New Application to Compute the Wisconsin Gait Score and 3-Dimensional Gait Analysis, and Reliability of the Application in Stroke Patients

“…hip FE ROM and pelvic oblique ROM on affected side (it was assumed that higher value of 3DGA hip FE ROM on affected side and lower value of 3DGA pelvic oblique ROM on affected side were better, corresponding to a lower score (better result) in App hip hiking at mid swing on affected side) (Mukaino et al, 2018). • App knee flexion from toe off to mid swing on affected side versus 3DGA knee FE ROM on affected side (it was assumed that higher value of 3DGA knee FE ROM on affected side was better, corresponding to a lower score (better result) in App knee flexion from toe off to mid swing on affected side) (Matsuda et al, 2016;Mukaino et al, 2018;Haruyama et al, 2021). • App toe clearance on affected side versus 3DGA total between ankle flex in initial contact phase (IC) and ankle flex in toe off phase (TO) on affected side (it was assumed that higher 3DGA total between ankle flex IC and ankle flex TO on affected side was better; patient more effectively controls the foot, and during the swing phase there is a lower risk of toe catch, while the ankle remains in dorsiflexion until it reaches the natural position; this corresponds to a lower score (better result) in App toe clearance on affected side) (Matsuda et al, 2016;Haruyama et al, 2021).…”

“…• App knee flexion from toe off to mid swing on affected side versus 3DGA knee FE ROM on affected side (it was assumed that higher value of 3DGA knee FE ROM on affected side was better, corresponding to a lower score (better result) in App knee flexion from toe off to mid swing on affected side) (Matsuda et al, 2016;Mukaino et al, 2018;Haruyama et al, 2021). • App toe clearance on affected side versus 3DGA total between ankle flex in initial contact phase (IC) and ankle flex in toe off phase (TO) on affected side (it was assumed that higher 3DGA total between ankle flex IC and ankle flex TO on affected side was better; patient more effectively controls the foot, and during the swing phase there is a lower risk of toe catch, while the ankle remains in dorsiflexion until it reaches the natural position; this corresponds to a lower score (better result) in App toe clearance on affected side) (Matsuda et al, 2016;Haruyama et al, 2021). • App pelvic rotation at terminal swing on affected side versus 3DGA pelvic rotation ROM on affected side (it was assumed that higher value of 3DGA pelvic rotation ROM on affected side was better, corresponding to a lower score (better result) in App pelvic rotation at terminal swing on affected side).…”

The Relationship between Gait Velocity and Walking Pattern in Hemiplegic Patients

“…Hemiparesis leads to impaired motion patterns, abnormal muscle activities and abnormal joint trajectories. Common features are decreased peak hip flexion, peak knee flexion-extension and foot dorsiflexion [14], which generally determine a problem with foot-floor clearance. Compensatory gait strategies to enhance progression and foot-floor clearance, such as circumduction, hip hiking and vaulting, have been described and recognized to increase energy expenditure [14][15][16] (Figure 1) All these gait patterns have some common features, but also some significant variations in terms of group muscles weakness and spasticity.…”

“…Common features are decreased peak hip flexion, peak knee flexion-extension and foot dorsiflexion [14], which generally determine a problem with foot-floor clearance. Compensatory gait strategies to enhance progression and foot-floor clearance, such as circumduction, hip hiking and vaulting, have been described and recognized to increase energy expenditure [14][15][16] (Figure 1) All these gait patterns have some common features, but also some significant variations in terms of group muscles weakness and spasticity. In the daily clinical practice, usually hemiplegic or hemiparetic patients adopt one of these gait patterns, but it is not unusual to find their combinations, with a prevalence of some features despite others in the activation sequence of muscles and strategy of progression.…”