Gait Disturbances in Patients With Stroke

Gait & Posture, 1996

The biomechanical patterns that characterize the gait of persons who have sustained a stroke are reviewed. Reduced walking speed and longer stance phases, greater on the unaffected side, are reported. Variations in joint excursions include several deviations at initial contact and reduced excursions during swing. Electromyographic patterns have provided a classification method. Joint moment reports were variable, but included high hip flexor moments in late stance, positively related to speed. The muscle groups of the una&ted side performed about 60% of the work of walking across speeds. Commonly occurring gait deviations resulting from particular impairments or adaptations to impairments are identified.

The Journal of Rehabilitation Research and Development

Mechanical methods of quantifying gait are more sensitive to change than is direct clinical inspection. To assess gait parameters and patterns of patients with stroke, and the temporal changes of these parameters, a foot-switch gait analyzer was used to test 49 ambulatory patients with stroke and 24 controls. Patients walked significantly slower than controls, with decreased cadence, increased gait cycle, and increased time in double limb support. Patients' hemiplegic limbs spent more time in swing and stance when compared to controls; their unaffected limbs spent significantly more time in stance and single limb support compared to controls. Patients' hemiplegic side, when compared with the unaffected side, spent less time in stance and more time in swing. A flatfoot pattern was typically noted on the affected side. General gait parameters improved over time, with the largest changes occurring in the first 12 months. However, the percentage of time spent in double and singl...

Journal of Stroke and Cerebrovascular Diseases, 1999

Background and Purpose: The purpose of this study was to assess the potential of a new quantitative kinematic analysis for the documentation and evaluation of recovery of gait function after neurological injury. Methods: We assessed the kinematics of gait function in 16 patients with hemiplegia at varying intervals over a 1-year period after a stroke, using a novel method for gait pattern assessment based on principal component analysis. Conventional measures such as gait speed and stride length were also evaluated. Testing started as soon as patients became ambulatory after stroke. Results: Of the 16 patients assessed, 7 showed at least a 50% increase in self-selected gait speed from the first to the last test. The results of the pattern analysis closely mirrored self-selected gait speed at higher speeds, but relative rankings derived from gait speed and the pattern analysis did not match for 6 of the 16 patients. Kinematic pattern analysis suggested that different mechanisms were used to generate changes in gait speed at different speed levels. Conclusion: There is a sizable fraction of the stroke population for whom kinematic gait pattern analysis can provide information that is different from that provided by speed, stride length, and cadence. The kinematic analysis can potentially provide information about the mechanisms of pathological gait.

The Pharma Innovation Journal, 2014

Stroke is one of the leading causes of mortality and morbidity worldwide. After a stroke, the ability to control balance in the sitting and standing positions is a fundamental skill of motor behavior for achieving autonomy in everyday activities. Initial walking function is impaired in two-thirds of the stroke population and this impairment is the greatest contributor to functional disability after stroke. Post-Stroke Hemiplegic gait is typical pattern of walking. The gait is a spastic gait affecting one leg; the ipsilateral arm may be held in a decorticate posture with hand near chest. It occurs after a contralateral hemispheric stroke and other corticospinal lesion. It possesses a complex anatomical picture to understand. This paper aims at reviewing post-stroke hemiplegic gait in detail and to look at the anatomical involvement, etiology, kinematics of hemiplegic gait and also to review available treatment modalities in this modern era.

Clinical Neurophysiology, 2007

A large proportion of stroke survivors have to deal with problems in mobility. Proper evaluations must be undertaken to understand the sensorimotor impairments underlying locomotor disorders post stroke, so that evidence-based interventions can be developed. The current electrophysiological, biomechanical, and imagery evaluations that provide insight into locomotor dysfunction post stroke, as well as their advantages and limitations, are reviewed in this paper. In particular, electrophysiological evaluations focus on the contrast of electromyographic patterns and integrity of spinal reflex pathways during perturbed and unperturbed locomotion between persons with stroke and healthy individuals. At a behavioral level, biomechanical evaluations that include temporal distance factors, kinematic and kinetic analyses, as well as the mechanical energy and metabolic cost, are useful when combined with electrophysiological measures for the interpretation of gait disturbances that are related to the control of the central nervous system or secondary to biomechanical constraints. Finally, current methods in imaging and transcranial magnetic stimulation can provide further insight into cortical control of locomotion and the integrity of the corticospinal pathways.

International Journal of Rehabilitation Research, 2019

Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (<3.4 km/h). High RSIs of stance and swing times were also observed (-9.62 ± 10.32 vs.-0.79 ± 2.93, 24.24 ± 25.75 vs. 1.76 ± 6.43, respectively). High ASIs and CVs were more generally observed, including the groups with gait speed of ≥3.5 km/h. ASI increase of the swing phase (25.79 ± 22.69 vs. 4.83 ± 4.88) and CV of the step length [7.7 ± 4.9 (paretic)/7.6 ± 5.0 (nonparetic) vs. 5.3 ± 3.0] were observed in all gait speed groups. Our data suggest that abnormalities in the spatiotemporal parameters of hemiparetic gait should be interpreted in relation to gait speed. ASIs and CVs could be highly sensitive indices for detecting gait abnormalities.

2020

Objective: To determine the abnormalities of different parameters of gait and to determine the association of spasticity with them in chronic post stroke population. Methodology: It was a cross sectional descriptive study conducted over a duration of 3 months in 2017 at Pakistan Institute of Medical Sciences, Islamabad and Railway General Hospital, Rawalpindi and included 104 chronic stroke patients using non probability purposive sampling technique. Patients presenting with both ischemic and hemorrhagic stroke, both genders having age of 25 year to 75 years, patients who had suffered from stroke in past 6 months at time of data collection were included in the study. Those patients who had weakness due to any tumor, Gullian Barre Syndrome, peripheral nerve injury, multiple sclerosis or traumatic brain injury were excluded from the study. Dynamic gait index, Modified Ashworth scale, 10 meter walk test and temporospatial characteristics like, step length, stride length, step width and...

Physical medicine and rehabilitation clinics of North America, 2013

Many stroke survivors have walking limitations. The results of gait training in individuals who have had strokes are characterized by large confidence intervals for mean differences in gait parameters. An individualized approach to therapy is needed, based on personalized gait pattern indicators and sensorimotor impairments. Three-dimensional gait analysis can help clinicians design the best locomotor training strategy for their patients, and can determine whether a patient is responding to the chosen intervention. Spatiotemporal parameters allow the characterization of the gait of hemiparetic patients but, used alone, they do not allow the cause of the deviations to be inferred.

Neurophysiologie Clinique/Clinical Neurophysiology, 2015

We reviewed neural control and biomechanical description of gait in both nondisabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke

Gait & Posture, 2008

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean AE S.D. age 57.7 AE 12.5 years and time since stroke 5.99 AE 6.46 months). Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p < 0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p < 0.01), single support time (CV 11.9% versus 6.3%, p < 0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p < 0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p < 0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability.