Abstract
In addition to changes in spatio-temporal and kinematic parameters, patients with stroke exhibit fear of falling as well as fatigability during gait. These changes could compromise interpretation of data from gait analysis. The aim of this study was to determine if the gait of hemiplegic patients changes significantly over successive gait trials. Forty two stroke patients and twenty healthy subjects performed 9 gait trials during a gait analysis session. The mean and variability of spatio-temporal and kinematic joint parameters were analyzed during 3 groups of consecutive gait trials (1–3, 4–6 and 7–9). Principal component analysis was used to reduce the number of variables from the joint kinematic waveforms and to identify the parts of the gait cycle which changed during the gait analysis session. The results showed that i) spontaneous gait velocity and the other spatio-temporal parameters significantly increased, and ii) gait variability decreased, over the last 6 gait trials compared to the first 3, for hemiplegic patients but not healthy subjects. Principal component analysis revealed changes in the sagittal waveforms of the hip, knee and ankle for hemiplegic patients after the first 3 gait trials. These results suggest that at the beginning of the gait analysis session, stroke patients exhibited phase of adaptation,characterized by a “cautious gait” but no fatigue was observed.
Highlights
About one half of stroke survivors present with motor impairments such as: synkinesis, abnormal muscle tone and orthopaedic deformations
The coefficient of variation (CV) of gait velocity, step length and double support time were significantly lower in T2 and T3 compared with T1 (p,0.05) and the CV of step width was significantly lower in T3 compared with T2 (p,0.01)
The results of this study clearly show that spatio-temporal parameters and sagittal kinematic waveforms change over several trials of a gait analysis session in stroke patients but not in healthy subjects
Summary
About one half of stroke survivors present with motor impairments such as: synkinesis, abnormal muscle tone and orthopaedic deformations. About 52 to 85% of hemiplegic patients regain the capacity to walk, but their gait differs from that of healthy subjects [1,2]. Hemiplegic gait is characterized by alterations in spatio-temporal and kinematic parameters [3]. Gait analysis is frequently carried out in clinical practice i) to identify gait impairments; ii) to determine appropriate treatments, and iii) to evaluate the effectiveness of interventions [4]. Threedimensional gait analysis is the gold standard for gait evaluation in patients with gait abnormalities [5]. It is used to simultaneously quantify spatio-temporal, kinematic, kinetic and electromyographic gait parameters. A review found moderate to good reliability for most biomechanical parameters during a gait analysis session [6]. It is important that data obtained with such methods identify true and significant changes in gait performance [5]
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