Control of lateral weight transfer is associated with walking speed in individuals post-stroke
Section snippets
Background
Stroke is a leading cause of long-term disability in the U.S (Go et al., 2014). The best way to reduce dependency after stroke is to improve walking ability (Barbeau and Fung, 2001, Solomon et al., 1994), which is commonly the most cited goal of people post-stroke (Duncan et al., 2007). A common characteristic of gait following stroke is decreased gait speed. Reduced velocity has been repeatedly shown as a reliable indicator of both pathological gait and general functional status (Olney and
Method
Thirty-six subjects (age, 58.2 ± 12.5 years; 3.7 ± 5.3 years post-stroke; 13 female; 13 right hemiparetic; comfortable walking speed, 0.7 ± 0.3 m/s; BERG score: 47.3 ± 8.9; Activities Specific Balance Confidence Scale: 76 ± 22) with hemiparesis after stroke participated. Participant inclusion criteria were a single cortical or subcortical stroke, at least 6 months post-stroke, sufficient cognitive function to follow instruction and communicate with the investigators, the ability to walk for 4 min without
Results
Average comfortable walking speed was 1.02 m/s for fast walkers (N = 22) and 0.48 m/s for slow walkers (N = 14). Compared to the faster walkers, slower walkers demonstrated increased paretic step width (p < 0.01) and lateral foot placement (p < 0.01) at initial ground contact, delayed weight transfer time during paretic double support phase (p < 0.05), and increased min COM-COP distance (p < 0.01), decreased hip abduction moment (p < 0.01), and decreased peak vertical GRF (p < 0.01) during paretic single limb
Discussion
In this study, we compared the characteristics of weight transfer during gait in slow versus fast post-stroke ambulators. The major finding was the delayed and deficient weight transfer to the paretic limb side in the slower walkers compared to faster walkers. Furthermore, slower walkers showed a lower hip abductor moment and more lateral paretic limb foot placement relative to their COM position, resulting in reduced COM motion toward their paretic limb side. These findings extend previous
Conclusions
Following stroke, gait rehabilitations efforts aimed at improving forward progression have been largely focused on sagittal plane movements. Although sagittal plane movements are more directly related to the outcome measures for forward progression such as walking speed, our findings suggested that the control of lateral weight transfer may also contribute to forward progression speed. These findings highlight the importance of improving lateral weight transfer function to enhance limb loading
Competing interests
None.
Author’s contributions
All authors have substantive contributions to the intellectual content and the drafting of the manuscript.
Source of funding
NIDRR H133P100014, NIH R01HD038582, NIH R01NR010786.
Acknowledgement
We thank Tom Zabielski for data processing.
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