Biomechanical differences between self-paced and fixed-speed treadmill walking in persons after stroke.

Abstract

Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed-speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. Twenty-five persons after stroke (10 males/15 females; 53±12.05years; 40.72±42.94months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM(t)), to statistically compare the kinematic and kinetic curves. The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p<0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p=0.007) and step length symmetry was significantly better (p=0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3°, < 0.1Nm/kg) and stride to stride variability was comparable in both conditions. Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.