Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

Abstract

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.

Biomechanical mechanisms underlying exosuit-induced improvements in walking economy after stroke

“…where X np and X p are, respectively, the biomechanical variables from the non-paretic and paretic limb (Nadeau, 2014). This index is always positive or zero, and 0% means perfect symmetry.…”

Evolving Toward Subject-Specific Gait Rehabilitation Through Single-Joint Resistive Force Interventions

“…Hemiparetic stroke patients have been observed to walk with a reduced paretic leg's foot trajectory in the sagittal plane of walking, essentially with a reduced area with shorter vertical and horizontal spans (Duschau-Wicke et al, 2009;Krishnan et al, 2012;Srivastava et al, 2016). A hemiparetic stroke patient may manifest multiple gait alterations, including multiple muscle weakness and spasticity (Carmo et al, 2012;Lauziere et al, 2014), but, interestingly, a single joint alteration in the current experiments resulted in seemingly similar deviations in the perturbed leg's foot trajectory. This is of interest, especially because some of the reported gait rehabilitation paradigms have successfully used robotic leg exoskeletons to apply external forces at multiple leg joints to achieve a desired foot trajectory performance by a hemiparetic stroke patient (Duschau-Wicke et al, 2009;Krishnan et al, 2012;Srivastava et al, 2016).…”

“…Incidentally, with aging or due to the occurrence of a neurological disorder, such as stroke, human performance while performing these actions degrades significantly (Ko et al, 2010;Carmo et al, 2012;Lauziere et al, 2014). Remarkably, there exists the potential to improve deviation from normal gait through proper rehabilitation methods.…”

“…In particular, muscle weakness and spasticity in individuals with neurological disorders, such as stroke, result in reduced joint range of motion, reduced weight bearing on the paretic leg, and asymmetric spatiotemporal gait parameters (Carmo et al, 2012). Studies have reported that, post-stroke (Lauziere et al, 2014), there is a lack of hip flexion moment from midstance to the late stance of the paretic limb. Furthermore, due to limited paretic ankle push-off capability, post-stroke patients demonstrate compensatory kinematic strategies, such as higher hip abduction and hip circumduction along the paretic limb.…”

Gait variability and symmetry assessment with inertial sensors for quantitative discrimination of Trendelenburg sign in total hip arthroplasty patients: a pilot study based on convenience sampling

“…In this sense, several measurements of spatiotemporal gait asymmetry have been proposed (Lauzière et al, 2014), and step length, stance time and swing time are gait features that provide reliable symmetry measurements (Lewek and Randall, 2011). Symmetry ratio, taken as the ratio between paretic and nonparetic step length, is a reliable measure of symmetry, being considered a good discriminator and an indicator of pathological condition if exceed 10% criterion for step length (Hodt-Billington et al, 2012).…”