Abstract
Gait asymmetry in spatial and temporal parameters and its impacts on functional activities have always raised many interesting questions in research and rehabilitation. The aim of this topical review is threefold: 1) to examine different equations of asymmetry of gait parameters and make recommendations for standardization, 2) to deepen the understanding of the relationships between sensorimotor deficits, spatiotemporal (step length, swing time and double support time) and biomechanical (kinematic, kinetic, muscular activity) parameter asymmetries during gait and, 3) to summarize the impacts of gait asymmetry on walking speed, falls, and energy cost in individuals post stroke. In light of current literature, we recommend quantifying spatiotemporal asymmetries by calculating symmetry ratios. However, for other gait parameters (such as kinetic or kinematic data), the choice will depend on the variability of the data and the objective of the study. Regardless of the selected asymmetry equation, we recommend presenting the asymmetry values in combination with the mean value of each side to facilitate comparisons between studies. This review also revealed that sensorimotor deficits clinically measured are not sufficient to explain the large variability of spatiotemporal asymmetries (particularly for step length and double support time) in individuals post stroke. Biomechanical analysis has been identified as a relevant approach to understanding gait deviations. Studies that linked biomechanical impairments to spatiotemporal asymmetries suggest that a balance issue and an impaired paretic forward propulsion could be among the important factors underlying spatiotemporal asymmetries. In our opinion, this paper provides meaningful information to aid in better understanding gait deviations in persons after stroke and establishes the need for future studies regrouping individuals post stroke according to their spatiotemporal asymmetries. Furthermore, further studies targeting efficacy of locomotor rehabilitation and the impacts of gait asymmetry on risk of falls and energy expenditure are needed.
Highlights
Stroke is one of the main causes of adult disability in most countries [1,2,3]
Recent studies suggested that the level of asymmetry in different gait parameters could be more relevant than walking speed to understand the degree of paretic leg impairment and the compensatory mechanisms used by individuals post stroke during locomotion [17,18]
To assess gait asymmetry in individuals post stroke, both level ground and treadmill walking studies have been analyzed since their results are globally comparable as mentioned by Kautz et al [33]
Summary
Stroke is one of the main causes of adult disability in most countries [1,2,3]. People living with stroke present several sensorimotor deficits such as contralateral and ipsilateral muscular weakness [4,5], contralateral spasticity [6,7], lack of coordination [8], contralateral impaired sensitivity [9,10,11], and impaired balance [12]. Recent studies suggested that the level of asymmetry in different gait parameters could be more relevant than walking speed to understand the degree of paretic leg impairment and the compensatory mechanisms used by individuals post stroke during locomotion [17,18].
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