Elsevier

Journal of Biomechanics

Volume 60, 26 July 2017, Pages 72-78
Journal of Biomechanics

Control of lateral weight transfer is associated with walking speed in individuals post-stroke

https://doi.org/10.1016/j.jbiomech.2017.06.021Get rights and content

Abstract

Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one’s body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N = 36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8 m/s or <0.8 m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors’ ability to increase walking speed.

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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