Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.
OBJECTIVE
To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke.


METHODS
Descriptive analysis of convenience sample.


METHODS
Outpatient rehabilitation clinic of a hospital in Taiwan.


METHODS
Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device.


METHODS
Not applicable.


METHODS
Subjects' maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GaitMatII.


RESULTS
Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R(2)=.57, R(2)=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R(2)=.76 for temporal asymmetry; R(2)=.46 for spatial asymmetry) and fast-speed (R(2)=.75 for temporal asymmetry; R(2)=.45 for spatial asymmetry) walking.


CONCLUSIONS
Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments.
Hsu
An-Lun
AL
Department of Physical Therapy, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
Tang
Pei-Fang
PF
Jan
Mei-Hwa
MH
D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation; D006429:Hemiplegia / Q000503:physiopathology* / Q000534:rehabilitation; D006615:Hip / Q000502:physiology; D006801:Humans; D007717:Knee / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009128:Muscle Spasticity / Q000534:rehabilitation; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology