Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.

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 (R(2)=.57, R(2)=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R(2)=.76 for temporal asymmetry; R(2)=.46 for spatial asymmetry) and fast-speed (R(2)=.75 for temporal asymmetry; R(2)=.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.