Walking Speed and Step Length Asymmetry Modify the Energy Cost of Walking After Stroke

Awad, Louis N.; Palmer, Jacqueline A.; Pohlig, Ryan T.; Binder‐Macleod, Stuart A.; Reisman, Darcy S.

doi:10.1177/1545968314552528

Cited by 171 publications

(181 citation statements)

References 35 publications

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“…Therefore, a decreased gait symmetry interferes with efficient gait performance (Mudge &Stott, 2009), andAwad et al (2015) further reported on the significant relationship between gait symmetry and the energy cost during walking in stroke patients.…”

Section: Discussionmentioning

confidence: 99%

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

Kijima¹,

Kiyama²,

Shimizu³

et al. 2018

Journal of Aging and Physical Activity

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The purpose of this study was to clarify whether a gait analysis using an accelerometer could estimate gait independence. Eighty-six stroke patients and 21 healthy control subjects participated in this study. Stroke patients were identified as dependent or independent based on their gait ability. The acceleration of the trunk and bilateral thigh was measured using three wireless sensors during walking. The root mean square, gait regularity, and symmetry were calculated from the acceleration to estimate gait quality. ANCOVA showed that gait regularity of the trunk and bilateral thigh were significantly lowest in the dependent group, regardless of gait velocity. A logistic regression analysis showed that the regularity and root mean square of the anteroposterior acceleration of the unaffected thigh were the key factors for estimating gait independence. This study suggests that an acceleration-based gait analysis facilities gait independence estimation, and is a useful tool during the rehabilitation of stroke patients.

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Section: Discussionmentioning

confidence: 99%

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

Kijima¹,

Kiyama²,

Shimizu³

et al. 2018

Journal of Aging and Physical Activity

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“…Previous studies have shown that step length asymmetry has negative functional consequences after stroke. Step length asymmetry is associated with reduced forward propulsion, slow walking speed and reduced dynamic balance (Balasubramanian et al, 2007; Bowden et al, 2006; Patterson et al, 2010), as well as an increased energy cost of walking (Awad et al, 2014; Mattes et al, 2000). Other evidence has shown that muscle activation in one leg directly facilitates out-of-phase muscle activation in the contralateral leg during cycling, thereby facilitating smooth reciprocal and symmetric timing of leg movement (Kautz et al, 2002; Ting et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Locomotor adaptation is influenced by the interaction between perturbation and baseline asymmetry after stroke

Tyrell

Helm

Reisman

2015

Journal of Biomechanics

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Stroke survivors without cerebellar involvement retain the ability to adapt to the split-belt treadmill, however it has been suggested that their rate of adaptation may be slowed compared to those who are neurologically intact. Depending on limb placement, the split-belt treadmill can be configured to either exaggerate baseline asymmetry, or reduce it, which may affect the behavior of adaptation or de-adaptation. The objectives of this study were to characterize the rate and magnitude of locomotor (de)adaptation in chronic stroke survivors compared to healthy matched subjects, and to evaluate whether exaggeration or reduction of baseline asymmetry impact the responses. Seventeen stroke survivors and healthy subjects completed 10 minutes of split-belt treadmill walking, then 5 minutes of tied-belt walking. Stroke survivors completed this once with each leg on the fast belt. Magnitude and rate of (de)adaptation were evaluated for step length and limb phase asymmetry. There were no differences between the groups with the exception of the reduced step length asymmetry configuration, in which case there was a significantly reduced magnitude (p=<0.000) and rate (p=0.011) of adaptation when compared to controls. There was a similar trend observed during post-adaptation for the exaggerated asymmetry group. The rate and magnitude of locomotor (de)adaptation is similar between chronic stroke survivors and neurologically intact controls, except when the adaptation or de-adaptation response would take the stroke survivors away from a symmetric step length pattern. This suggests that there may be some benefit to symmetry that is recognized by the system.

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“…Still the screening must be meticulous and the treatment must be early initiated, so that the program yields the best response with the lowest cost possible. 19 We emphasize that, after the hospital discharge of the stroke patients, the referrals to rehabilitation programs must be done the earliest possible. However, due to precarious health systems in developing countries, such as Brazil, these patients rarely initiate the rehabilitation program short after the stroke event.…”

Section: 13mentioning

confidence: 99%

Intensive hospital rehabilitation model for patients with stroke in a developing country

Filippo¹,

Alfieri²,

Daniel

et al. 2017

Acta Fisiátrica

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Intensive rehabilitation services with standardized treatment for stroke survivors are desirable once they contribute to the patients' functional improvement even in facilities with restricted financial resources. Objective: To verify whether the stroke program at our public inpatient Rehabilitation Center contributes to improvements in functional outcome. Method: This is a retrospective cross-sectional study of the first and last 100 neurological patients (2009-2010 and 2014-2015) admitted at the Lucy Montoro Rehabilitation Network (Morumbi Unit). For this study, the patients were analyzed at admission and at discharge by the modified Rankin Scale (mRS). After testing for normality, an unpaired t-test was on the patients' clinical and demographic characteristics. Intragroup analysis was performed by the nonparametric Wilcoxon test. The intergroup analysis used the Mann-Whitney nonparametric test. Functional outcome scores ≤ 3 at discharge were considered favorable. Results: The modified Rankin Scores (mRS) were assessed just before the initiation of the therapies and at the patients' discharge. Median mRS score at admission was 4 compared to 3 at discharge (p=0.0001), after 4 to 6 weeks in the stroke program. Conclusions: Short term, standardized intensive rehabilitation program with multidisciplinary therapies, in which the patient remains hospitalized, promote functional improvements of patients with stroke sequelae.

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Walking Speed and Step Length Asymmetry Modify the Energy Cost of Walking After Stroke

Cited by 171 publications

References 35 publications

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

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

Locomotor adaptation is influenced by the interaction between perturbation and baseline asymmetry after stroke

Intensive hospital rehabilitation model for patients with stroke in a developing country

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