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Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study.

Meijer R, Plotnik M, Zwaaftink EG, van Lummel RC, Ainsworth E, Martina JD, Hausdorff JM - J Neuroeng Rehabil (2011)

Bottom Line: The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear.A significant correlation between GA and PCI was seen in the stroke patients (r = 0.94; p < 0.001), but not in the controls.In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rehabilitation Medical Centre Groot Klimmendaal, Department of Innovation, Research & Education, Room K009, PO Box 9044, 6800 GG Arnhem, Netherlands. r.meijer@grootklimmendaal.nl

ABSTRACT

Background: Multiple aspects of gait are typically impaired post-stroke. Asymmetric gait is common as a consequence of unilateral brain lesions. The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear. The objective of this exploratory study is to quantify the effects of hemiparesis on two putatively independent aspects of the bilateral coordination of gait to gain insight into mechanisms and their relationship and to assess their potential as clinical markers.

Methods: Twelve ambulatory stroke patients and age-matched healthy adults wore a tri-axial piezo-resistive accelerometer and walked back and forth along a straight path in a hall at a comfortable walking speed during 2 minutes. Gait speed, gait asymmetry (GA), and aspects of the bilateral coordination of gait (BCG) were determined. Bilateral coordination measures included the left-right stepping phase for each stride φi, consistency in the phase generation φ_CV, accuracy in the phase generation φ_ABS, and Phase Coordination Index (PCI), a combination of accuracy and consistency of the phase generation.

Results: Group differences (p < 0.001) were observed for gait speed (1.1 ± 0.1 versus 1.7 ± 0.1 m/sec for patients and controls, respectively), GA (26.3 ± 5.6 versus 5.5 ± 1.2, correspondingly) and PCI (19.5 ± 2.3 versus 6.2 ± 1.0, correspondingly). A significant correlation between GA and PCI was seen in the stroke patients (r = 0.94; p < 0.001), but not in the controls.

Conclusions: In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired. Although these features are not related to each other in healthy controls, they are strongly related in stroke patients, which is a novel finding. A measurement approach based on body-fixed sensors apparently may provide sensitive markers that can be used for clinical assessment and for enhancing rehabilitation targeting in post-stroke patients.

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Related in: MedlinePlus

a + b: Left and right swing time values for all the strides of the two minute walk are shown for a healthy adult (figure 1a) and a patient (figure 1 b). Mean values of the right leg swing times were 0.47 seconds and 0.43 seconds for the control and stroke patient, respectively. The corresponding values for the left leg (paretic leg of the stroke patient) were 0.45 seconds and 0.64 seconds, respectively Healthy adult: mean number of steps/minute: 103; mean gait speed: 1.28 m/s. Stroke patient: mean number of steps/minute: 78.5; mean gait speed: 0.65 m/s. Both healthy adult and stroke patient had a number of steps/minute and gait speed in the bottom range of their groups (Table 2).
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Figure 1: a + b: Left and right swing time values for all the strides of the two minute walk are shown for a healthy adult (figure 1a) and a patient (figure 1 b). Mean values of the right leg swing times were 0.47 seconds and 0.43 seconds for the control and stroke patient, respectively. The corresponding values for the left leg (paretic leg of the stroke patient) were 0.45 seconds and 0.64 seconds, respectively Healthy adult: mean number of steps/minute: 103; mean gait speed: 1.28 m/s. Stroke patient: mean number of steps/minute: 78.5; mean gait speed: 0.65 m/s. Both healthy adult and stroke patient had a number of steps/minute and gait speed in the bottom range of their groups (Table 2).

Mentions: The gait of the stroke patients is characterized by an elongation in swing times in the paretic leg and increased GA (see Figure 1). Swing times of the left and right legs are plotted for the complete walking trial for a patient and control subject. For the control subject, swing values for the left and right leg virtually overlap. In contrast, for the patient with left hemiparesis, comparable swing values are seen only for the intact (right) leg and clear elongation in swing times is seen for the paretic (left) leg. Accordingly, GA is almost ten times higher for this stroke patient as compared to the control subject (see formula 1). The average value of GA in the patients was about 4 times larger than in the controls (see Table 2).


Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study.

Meijer R, Plotnik M, Zwaaftink EG, van Lummel RC, Ainsworth E, Martina JD, Hausdorff JM - J Neuroeng Rehabil (2011)

a + b: Left and right swing time values for all the strides of the two minute walk are shown for a healthy adult (figure 1a) and a patient (figure 1 b). Mean values of the right leg swing times were 0.47 seconds and 0.43 seconds for the control and stroke patient, respectively. The corresponding values for the left leg (paretic leg of the stroke patient) were 0.45 seconds and 0.64 seconds, respectively Healthy adult: mean number of steps/minute: 103; mean gait speed: 1.28 m/s. Stroke patient: mean number of steps/minute: 78.5; mean gait speed: 0.65 m/s. Both healthy adult and stroke patient had a number of steps/minute and gait speed in the bottom range of their groups (Table 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111353&req=5

Figure 1: a + b: Left and right swing time values for all the strides of the two minute walk are shown for a healthy adult (figure 1a) and a patient (figure 1 b). Mean values of the right leg swing times were 0.47 seconds and 0.43 seconds for the control and stroke patient, respectively. The corresponding values for the left leg (paretic leg of the stroke patient) were 0.45 seconds and 0.64 seconds, respectively Healthy adult: mean number of steps/minute: 103; mean gait speed: 1.28 m/s. Stroke patient: mean number of steps/minute: 78.5; mean gait speed: 0.65 m/s. Both healthy adult and stroke patient had a number of steps/minute and gait speed in the bottom range of their groups (Table 2).
Mentions: The gait of the stroke patients is characterized by an elongation in swing times in the paretic leg and increased GA (see Figure 1). Swing times of the left and right legs are plotted for the complete walking trial for a patient and control subject. For the control subject, swing values for the left and right leg virtually overlap. In contrast, for the patient with left hemiparesis, comparable swing values are seen only for the intact (right) leg and clear elongation in swing times is seen for the paretic (left) leg. Accordingly, GA is almost ten times higher for this stroke patient as compared to the control subject (see formula 1). The average value of GA in the patients was about 4 times larger than in the controls (see Table 2).

Bottom Line: The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear.A significant correlation between GA and PCI was seen in the stroke patients (r = 0.94; p < 0.001), but not in the controls.In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rehabilitation Medical Centre Groot Klimmendaal, Department of Innovation, Research & Education, Room K009, PO Box 9044, 6800 GG Arnhem, Netherlands. r.meijer@grootklimmendaal.nl

ABSTRACT

Background: Multiple aspects of gait are typically impaired post-stroke. Asymmetric gait is common as a consequence of unilateral brain lesions. The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear. The objective of this exploratory study is to quantify the effects of hemiparesis on two putatively independent aspects of the bilateral coordination of gait to gain insight into mechanisms and their relationship and to assess their potential as clinical markers.

Methods: Twelve ambulatory stroke patients and age-matched healthy adults wore a tri-axial piezo-resistive accelerometer and walked back and forth along a straight path in a hall at a comfortable walking speed during 2 minutes. Gait speed, gait asymmetry (GA), and aspects of the bilateral coordination of gait (BCG) were determined. Bilateral coordination measures included the left-right stepping phase for each stride φi, consistency in the phase generation φ_CV, accuracy in the phase generation φ_ABS, and Phase Coordination Index (PCI), a combination of accuracy and consistency of the phase generation.

Results: Group differences (p < 0.001) were observed for gait speed (1.1 ± 0.1 versus 1.7 ± 0.1 m/sec for patients and controls, respectively), GA (26.3 ± 5.6 versus 5.5 ± 1.2, correspondingly) and PCI (19.5 ± 2.3 versus 6.2 ± 1.0, correspondingly). A significant correlation between GA and PCI was seen in the stroke patients (r = 0.94; p < 0.001), but not in the controls.

Conclusions: In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired. Although these features are not related to each other in healthy controls, they are strongly related in stroke patients, which is a novel finding. A measurement approach based on body-fixed sensors apparently may provide sensitive markers that can be used for clinical assessment and for enhancing rehabilitation targeting in post-stroke patients.

Show MeSH
Related in: MedlinePlus