Should trunk movement or footfall parameters quantify gait asymmetry in chronic stroke patients?

Abstract

The purpose of this study was to investigate gait asymmetry in chronic stroke patients in comparison with subjects with no known asymmetries. Further, we wanted to decide which gait symmetry parameter has the best ability to discriminate between the two groups. Twenty subjects with hemiplegia (mean age 58 years, S.D.=8 years) and 57 subjects with no known gait asymmetry (mean age 77 years, S.D.=5 years) walked six times along a 7-m walkway at slow, preferred and fast speed. Measures of vertical, anteroposterior, and mediolateral trunk asymmetry were assessed from triaxial accelerometry data. The footfall parameters of single support (% of stride time) and step length (m) asymmetry were assessed from data obtained using an electronic walkway. Vertical (p<0.001), anteroposterior (p=0.01), mediolateral (p=0.01) trunk movement and single support (p=0.03) showed significant differences in asymmetry between the two groups. No difference in step length asymmetry was found between the two groups. Neither single support asymmetry nor step length asymmetry showed the ability to discriminate subjects with hemiplegic gait from subjects in the comparison group. Measures of trunk movement asymmetry, however, were able to discriminate between the two groups (p<or=0.001). The results indicate that trunk movement should be included in the assessment of gait asymmetry in chronic stroke patients.

Understanding Inconsistent Step-Length Asymmetries Across Hemiplegic Stroke Patients

“…[1][2][3][6][7][8][9][10]12,18 First, we found that asymmetry in neither component was significantly correlated with mean step-length asymmetry, indicating that variations in step-length asymmetry cannot be fully explained by the components of trunk progression (TP) and forward foot placement relative to the trunk (FFP) in isolation. Second, Figure 2 clearly shows that step-length asymmetry is, by and large, the sum of asymmetries in TP and FFP.…”

“…1,3 As a result, the trunk does not displace as far forward of the supporting foot during paretic single limb support, resulting in shorter nonparetic than paretic steps ( Figure 1A). Hodt-Billington and colleagues 12 recently concluded, however, that footfall and trunk movements reflect different aspects of hemiplegic gait, implying that asymmetries in trunk progression alone may not fully explain the variations observed in step-length asymmetry. 6,7,13 Another contributor to step-length asymmetry may be differences between paretic and nonparetic forward foot placement relative to the trunk at foot-strike: the farther the nonparetic leg is swung forward with respect to the trunk, the larger the nonparetic step (provided that the trunk is advanced equally far forward during paretic and nonparetic steps; Figure 1B).…”

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

“…Indication exists that the asymmetries frequently seen in gait parameters poststroke also affect upper-body movements, resulting in asymmetric arm-swing patterns [41]. The hemiparetic gait of patients with stroke is often associated with an adducted arm with no or limited arm swing on the affected side.…”

Reliability and validity of trunk accelerometry-derived performance measurements in a standardized heel-rise test in elderly subjects

“…Several investigations have been conducted using accelerometers for the quantification of gait [13][14][15][16][17][18][19][20][21][22][23], chair rising [24][25], and balance [20,[25][26][27]. High reproducibility has been found using trunk accelerometry for the measurement of spatiotemporal gait parameters [14][15] and accelerations during gait [15,20].…”