Article
Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke1,

https://doi.org/10.1016/S0003-9993(03)00030-3Get rights and content

Abstract

Hsu A-L, Tang P-F, Jan M-H. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003;84:1185–93.

Objective:

To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke.

Design:

Descriptive analysis of convenience sample.

Setting:

Outpatient rehabilitation clinic of a hospital in Taiwan.

Participants:

Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device.

Interventions:

Not applicable.

Main Outcome Measures:

Subjects’ maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GaitMatII.

Results:

Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R2=.57, R2=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R2=.76 for temporal asymmetry; R2=.46 for spatial asymmetry) and fast-speed (R2=.75 for temporal asymmetry; R2=.45 for spatial asymmetry) walking.

Conclusions:

Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments.

Section snippets

Participants

Subjects with hemiplegia resulting from a single onset of stroke were recruited from the outpatient rehabilitation clinic of a local hospital in Taipei, Taiwan, Republic of China. Inclusion criteria were ability to communicate with others; to walk independently without any assistance or device for at least 10m; and to actively flex the affected hip, to extend the affected knee, and to plantarflex the affected ankle. Patients with limitations in joint range of motion or pain in the lower

Results

Twenty-six patients (19 men, 7 women) participated in this research. The mean age of the subjects was 54.2 years (range, 30–69y) and the average postonset duration was 10.3 months (range, 1–43mo). Fourteen subjects had right-side hemiparesis, and the rest had left-side hemiparesis. The etiology for half the subjects was cerebral infarction; the other half had cerebral hemorrhage. Table 1 summarizes the subjects’ demographic characteristics, motor and sensory scores, and spasticity score of the

Discussion

Our study investigated the relationship between direct impairments (muscle strength, motor and sensory function of the affected lower extremity, spasticity of the affected ankle plantarflexors) and gait performance (gait velocity, temporal and spatial asymmetry) in patients with mild to moderate stroke without significant cognitive or visuospatial perception disorders. This study also identified direct impairments that determine gait velocity and asymmetry in these patients. All subjects showed

Conclusion

Gait velocity and asymmetry were differentially affected by the investigated direct impairments in hemiplegic patients after mild to moderate stroke. Strength of the affected hip flexors and knee extensors were the most important factors determining the comfortable and fast gait velocities, respectively. However, spasticity of the ankle plantarflexors appeared to be the critical factor determining the temporal and spatial asymmetry of hemiplegic gait. Therapeutic interventions to improve gait

References (58)

  • A Nene et al.

    Assessment of rectus femoris function during initial swing phase

    Gait Posture

    (1999)
  • M.E Brandstater et al.

    Hemiplegic gaitanalysis of temporal variables

    Arch Phys Med Rehabil

    (1983)
  • E Knutsson et al.

    Different types of disturbed motor control in gait of hemiplegic patients

    Brain

    (1979)
  • S.J Olney et al.

    Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegiaa regression approach

    Phys Ther

    (1994)
  • D.T Wade et al.

    Walking after stroke

    Scand J Rehabil Med

    (1987)
  • M.P Murray et al.

    Walking patterns in healthy old men

    J Gerontol

    (1969)
  • M.A Dettmann et al.

    Relationship among gait performance, postural stability, and function assessments of the hemiplegic patient

    Am J Phys Med

    (1987)
  • J.C Wall et al.

    Gait asymmetries in residual hemiplegia

    Arch Phys Med Rehabil

    (1986)
  • R.W Bohannon et al.

    Rehabilitation goals of patients with hemiplegia

    Int J Rehabil Res

    (1988)
  • R.W Bohannon et al.

    Importance of 4 variables of gait to patients with stroke

    Int J Rehabil Res

    (1991)
  • R.W Bohannon

    Gait performance of hemiparetic stroke patientsselected variables

    Arch Phys Med Rehabil

    (1987)
  • R.W Bohannon

    Selected determinants of ambulatory capacity in patients with hemiplegia

    Clin Rehabil

    (1989)
  • R.W Bohannon

    Knee extension force measurements are reliable and indicative of gait speed in stroke patients

    Int J Rehabil Res

    (1989)
  • R.W Bohannon et al.

    Correlation of knee extensor muscle torque and spasticity with gait speed in patients with stroke

    Arch Phys Med Rehabil

    (1990)
  • R.W Bohannon et al.

    Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke

    Arch Phys Med Rehabil

    (1992)
  • S Nadeau et al.

    Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke

    Am J Phys Med Rehabil

    (1999)
  • R Nakamura et al.

    Relationship of muscle strength for knee extension to gait capacity in patients with spastic hemiparesis

    Tohoku J Exp Med

    (1985)
  • R Nakamura et al.

    The relationship between gait speed and muscle strength for knee extension in hemiparetic stroke patientsa follow-up study

    Tohoku J Exp Med

    (1988)
  • K Suzuki et al.

    Determinants of maximum walking speed in hemiparetic stroke patients

    Tohoku J Exp Med

    (1990)
  • Cited by (496)

    View all citing articles on Scopus

    Supported in part by a graduate fellowship from the Mackay Memorial Hospital, Taipei, Taiwan, ROC.

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

    View full text