Computerised Dynography in Hemiparesis: Case study (2025)

Gait characteristics of post-stroke hemiparetic patients with different walking speeds

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.

Relationship Between Step Length Asymmetry and Walking Performance in Subjects With Chronic Hemiparesis

Archives of Physical Medicine and Rehabilitation, 2007

Objective: To understand the relationship between step length asymmetry and hemiparetic walking performance. Design: Descriptive. Setting: Gait analysis laboratory. Participants: Convenience sample of 49 subjects with chronic hemiparesis. Interventions: Not applicable. Main Outcome Measures: Subjects walked at their selfselected walking speed over both an instrumented mat and forceplates to collect spatiotemporal parameters and ground reaction forces, respectively. Step length asymmetry was quantified by using a step length ratio (SLR) defined as paretic step length divided by nonparetic step length. Paretic leg propulsion, selfselected walking speed, hemiparetic severity (assessed by Brunnstrom stages of motor recovery), and some spatiotemporal walking parameters quantified the hemiparetic walking performance. Paretic leg propulsion was quantified by the paretic propulsion (P P) ratio, calculated as the percentage contribution of paretic leg to the total propulsive impulse. Results: Significant negative correlation (rϭϪ.78) was revealed between SLR and P P , indicating that subjects generating less propulsive force with the paretic leg walked asymmetrically with longer paretic steps than nonparetic steps. SLR and self-selected walking speed revealed a weaker correlation (rϭϪ.35), whereas hemiparetic severity correlated strongly with SLR (ϭϪ.53). Conclusions: Step length asymmetry is related to propulsive force generation during hemiparetic walking. Subjects generating least paretic propulsion walk with relatively longer paretic steps. This suggests that one of the mechanisms for the longer paretic step may be the relatively greater compensatory nonparetic leg propulsion. Further, those with more severe hemiparesis (those dependent on abnormal flexor and extensor synergies) walk with the longest paretic steps relative to non-paretic. Finally, our results indicated that asymmetrical step lengths may not necessarily limit the self-selected walking speed, likely due to other compensatory mechanisms.

Validity of gait asymmetry estimation by using an accelerometer in individuals with hemiparetic stroke

Journal of Physical Therapy Science, 2017

The purpose of this study was to evaluate the validity of estimating step time and length asymmetries, using an accelerometer against force plate measurements in individuals with hemiparetic stroke. [Subjects and Methods] Twenty-four individuals who previously had experienced a stroke were asked to walk without using a cane or manual assistance on a 16-m walkway. Step time and length were measured using force plates, which is the gold standard for assessing gait asymmetry. In addition to ground reaction forces, trunk acceleration was simultaneously measured using an accelerometer. To estimate step time asymmetry using accelerometer data, the time intervals between forward acceleration peaks for each leg were calculated. To estimate step length asymmetry using accelerometer data, the integration of the positive vertical accelerations following initial contact of each leg was calculated. Asymmetry was considered the affected side value divided by the unaffected side value. [Results] Significant correlations were found between the accelerometer and the force plates for step time and length asymmetries (rho=0.83 and rho=0.64, respectively). [Conclusion] An accelerometer might be useful for assessing step time and length asymmetries in individuals with hemiparetic stroke, although improvements are needed for estimating the accuracy of step length asymmetry.

Stabilometry is a predictor of gait performance in chronic hemiparetic stroke patients

Gait & Posture, 2009

Kinematic and Kinetic Analyses of Gait Patterns in Hemiplegic Patients Udc

2004

As lack of standardization in the visual and computerized gait analyses different kinetic and kinematic gait analysis methods have been developed. The goal of this study was to further investigate the individually characteristics biomechanical deficits of hemiparetic gait pattern and the resulting compensations that compromise walking. The stance phase was more closely examined by the means of a force plate system and a motion analysis system. Data were obtained for both the affected and unaffected leg of 11 (9 males, 2 females) hemiplegic patients. We found that the shorter stance phase time for the affected side is related to the deficient ability to load and transfer weight through their affected leg. Significantly increased rate of force development was found during foot flat on the affected side while toe off was characterized by markedly lower force development. The impaired range of motion on the hemiplegic side was also leading to compensatory mechanism of the unaffected lim...

Quantitative assessment of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip in hemiplegia using three-dimensional treadmill gait analysis

Topics in Stroke Rehabilitation, 2018

Background: Most people with hemiplegia experience gait changes after a stroke. Abnormal gait patterns in stroke patients vary across subjects and this make it difficult to assess the cause of gait abnormalities. Therefore, it is necessary to quantitatively evaluate abnormal gait patterns through gait analysis for stroke patients. Objective: To develop and evaluate the validity of quantitative assessments of the degree of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip. Methods: Forty-six healthy control subjects and 112 people with hemiplegia participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern (knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip) with some overlap. Participants were instructed to walk on a treadmill and were recorded using a threedimensional motion analysis system. An index to quantify each of the four abnormal gait patterns exhibited by the patients was calculated from the three-dimensional coordinate data. The indices were developed based on the definition of the abnormal gait patterns. The index values for the patients were compared with those of healthy subjects as well as with the results of observational gait assessment by three physical therapists with expertise in gait analysis. Results: Strong correlation was observed between the index value and the median observational rating for all four abnormal gait patterns (-0.64 to -0.86). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. Conclusions: The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.

Hemiparetic gait following stroke. Part I: Characteristics

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 use of the Gait Deviation Index for the evaluation Post-stroke Hemiparetic Subjects

Medical Express, 2017

The Gait Deviation Index, initially conceived to evaluate the gait of children with cerebral palsy, has been used as a quantitative parameter of gait pattern changes of individuals with other conditions. However, there are no studies evaluating changes in the gait pattern of chronic hemiparetic post-stroke subjects based on this index. AIMS: To characterize the changes in gait pattern according to the Gait Deviation Index and gait spatiotemporal parameters of chronic hemiparetic subjects compared to healthy subjects. METHODS: Retrospective study. Data were obtained from the database of the Gait Laboratory of Hospital Israelita Albert Einstein. Thirty subjects were included in this study, with previous unilateral, ischemic or hemorrhagic chronic stroke (time post-lesion > 6 months) and ability of walking classified as 2, 3, 4 or 5 according to Functional Ambulation Category. Data from 87 healthy subjects were included in control group, obtained from a normality database. Statistical analysis was applied through the Kruskall Wallis test, followed by Mann-Whitney post-hoc test, considering a critical p value <0.05. The Gait Deviation Index scores were decreased for both paretic (64.69 ± 16.29) and non-paretic limbs (64.88 ± 15.00) compared to control (101.01 ± 10.12; p < 0.001). No differences were observed in Gait Deviation Index scores between paretic and non-paretic limbs (p > 0.99). The findings of the current study demonstrate that the Gait Deviation Index may be a sensitive parameter to identify changes in the gait pattern of chronic hemiparetic post-stroke subjects.

The Relationship between Gait Velocity and Walking Pattern in Hemiplegic Patients

Applied Sciences

Background Gait speed represents a functional predictor and an impairment severity index in stroke survivors; gait analysis parameters are descriptors of walking strategies used to compensate for the muscle impairment such as vaulting, circumduction and hip hiking. The aim of this study was to assess if there is a relationship between the gait compensatory strategy and gait speed of progression. Methods A sample of 30 patients with post-stroke hemiparesis was assessed for gait compensatory patterns through gait analysis and videorecording. BMI, pain-VAS, Barthel Index, Nottingham Extended ADL Scale, Motricity Index, lower limb muscles strength and aROMs were also included in the assessment. Results In 19 patients it was possible to identify one or more compensatory strategies; in 11 patients no specific gait pattern was found. The vaulting and hip hiking combined gait strategy had an effect on gait speed. Gait speed was directly related to Barthel Index, Nottingham Extended ADL Scal...

Editorial: Use of computerized gait analysis in neurological pathologies

Frontiers in Human Neuroscience, 2022