Abstract
BackgroundComparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.MethodsFive patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed (e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.ResultsSpatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.ConclusionComparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal (i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.
Highlights
Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed
Previous authors have noticed that the intralimb coordinative patterns of chronic hemiparetics walking overground at their preferred speed can be characterized by asymmetry between unaffected and affected sides [7], and that the botulinum toxin injections into the rectus femoris of the paretic side can improve the thigh-leg coordination patterns of both limbs [8]
Spatio-temporal parameters The two-way ANalysis Of VAriance (ANOVA) of data related to the hemiparetic subjects (HMs) group (Figure 1 and Table 2) revealed that STs did not differ between affected and unaffected sides but were significantly (p
Summary
Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. Previous authors have already highlighted the importance of considering gait metrics in relation to the walking speed when attempting to classify gait abnormality [11,12] This is because the velocity can be viewed as a control parameter of the dynamic system that, when scaled, involves changes of coordination even within the gait of walking alone [7,13]. In a previous study, Monaco and colleagues [14] demonstrated that the gait analysis, when carried out at controlled and comparable speed, can better pinpoint features between young and elderly healthy subjects than the comparison at self-selected pace
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