Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke.
BACKGROUND
Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking.


METHODS
Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household <0.4m/s, Limited Community 0.4-0.8m/s, Community >0.8m/s).


RESULTS
While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P<.05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction.


CONCLUSIONS
These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.
Dept. of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. Electronic address: Vstan@udel.edu.
Victoria A
VA
Stanhope
Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA.
Brian A
BA
Knarr
Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.
Darcy S
DS
Reisman
Dept. of Physical Therapy, University of Delaware, Newark, DE, USA; Dept. of Mechanical Engineering, University of Delaware, Newark, DE, USA.
Jill S
JS
Higginson
D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005528:Foot / Q000503:physiopathology; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology*; D006615:Hip / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000503:physiopathology*; D016138:Walking / Q000502:physiology*
Circumduction; Gait; Kinematics; Stroke