Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke

doi:10.1016/S0966-6362(02)00122-4

Gait & Posture

Volume 18, Issue 1, August 2003, Pages 23-28

https://doi.org/10.1016/S0966-6362(02)00122-4 Get rights and content

Abstract

The purpose of this study was to (1) determine whether symmetry in temporal-distance (T-D) measures is accompanied by symmetry in kinetic measures during self-paced gait and (2) evaluate the effect of symmetry on gait speed in individuals with chronic stroke. A symmetry index was calculated for stance time, swing time, step length and vertical ground reaction force (GRF) for 28 individuals with stroke (age: 62.5±8.2 years). Spearman correlation revealed that (a) gait speed was correlated with the symmetry of temporal measures and GRF and (b) symmetry in GRF was correlated with symmetry in temporal but not distance measures of gait (P<0.05). The results provide support for promoting temporal and kinetic symmetry in the gait of persons with stroke.

Introduction

In healthy individuals, gait patterns with respect to time, distance and vertical force are fairly symmetrical deviating by only a small percentage from perfect symmetry. For example, the difference between the two lower limbs calculated using a symmetry index [1] for temporal measures and vertical force were reported to be less than 6% in able-bodied gait [2], [3], [4]. In pathological gait, however, marked asymmetry has been noted between the affected and unaffected lower limbs. Shorter stance time, prolonged swing time and decreased ground reaction forces (GRFs) have been reported on the affected limb relative to the unaffected limb in the gait of persons with stroke, osteoarthritis, and in persons with prosthetic limbs [4], [5], [6], [7], [8], [9].

Does the degree of gait asymmetry relate to measures of motor recovery and function in persons with stroke? Brandstater et al. [10] found that symmetry of swing time was related to the stage of motor recovery and gait speed in a group of persons with acute stroke. Similarly, Titianova and Tarkka [4] also found a significant relationship between the symmetry for swing time and gait speed in a group of chronic stroke survivors. In contrast, other studies have found this relationship to be non-significant in persons with chronic stroke [11], [12], [13]. Nonetheless, despite the contrasting results, studies continue to use temporal-distance (T-D) symmetry as an indicator of gait performance and a measure for evaluating intervention strategies [14], [15], [16].

Although T-D symmetry is commonly analyzed, the symmetry in kinetic measures is rarely examined in persons with stroke. Kinetic variables (e.g. force) may be considered more informative since they provide insight into the cause, rather than the effect, of the movement [17], [18]. One study [7] has analyzed the relationship between symmetry of the impulse of GRF and gait speed in persons with stroke and found a significant correlation, thereby concluding that GRF well reflects gait ability in these individuals.

In addition, it is not known how T-D symmetry relates to the symmetry of kinetic variables (e.g. GRF) during gait. Therefore, the purpose of this study was to determine whether symmetry in T-D measures (stance time, swing time, and step length) is accompanied by symmetry in GRF measures during gait and in addition, quantify the relationship between the symmetry of these variables and gait speed in a group of individuals with chronic stroke.

Section snippets

Subjects

Twenty-eight individuals with hemiparesis caused by a single cerebrovascular accident volunteered to participate in the study. Inclusion criteria for this study were: (1) at least 6 months post stroke, (2) age 50 or over, and (3) able to ambulate independently without an assistive device. Subjects who had orthopaedic or neurological conditions in addition to the stroke were excluded from the study. Ethics approval was obtained from the university and local hospital ethics committees. Each

Results

Subject characteristics and mean values of all gait measures including the symmetry indices are presented in Table 1, Table 2, respectively. The coefficient of variation (CV) across the five trials for the T-D and GRF measures was low. The CV for stance time was 5±3% (across the 28 subjects for the paretic and nonparetic limbs), for swing time 7±4%, for step length 6±4%, and for vertical GRF 3±1%. All subjects were able to walk without walking aids, however, five subjects required the use of an

Degree and pattern of gait asymmetry

The subjects that participated in this study presented a wide range of functional levels as was evident by their stage level on the Chedoke–McMaster Stroke Assessment [19] (range 2–7) and the range in gait speed (0.34–1.42 m/s). The mean symmetry indices deviated considerably from zero (i.e. perfect symmetry). The magnitudes of the symmetry indices found in this study were similar in range with findings previously reported by others [4] using the same symmetry index for temporal gait measures

Acknowledgements

We wish to acknowledge the support of the BC Health Research Foundation, a Grant-in-Aid from the Heart and Stroke Foundation of BC and Yukon, and the BC Medical Services Foundation.

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Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke

Abstract

Introduction

Section snippets

Subjects

Results

Degree and pattern of gait asymmetry

Acknowledgements

Gait Posture

Hum. Mov. Sci.

Gait Posture

Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry

J. Manipulative Physiol. Ther.

Asymmetries in ground reaction force patterns in normal human gait

Med. Sci. Sports Exerc.

Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction

J. Rehabil. Res. Dev.

Lower extremity bearing under various standing conditions in independently ambulatory patients with hemiparesis

Phys. Ther.

Improvement in function after valgus bracing of the knee: an analysis of gait symmetry

J. Bone Jt. Surg.

Gait analysis of hemiplegic patients by measurement of ground reaction force

Scand. J. Rehabil. Med.

Gait analysis in amputee

Am. J. Phys. Med.

Assessment of gait disability in hemiplegics

Scand. J. Rehabil. Med.

Hemiplegic gait: analysis of temporal variables

Arch. Phys. Med. Rehabil.

Relationships between walking performance, postural stability and functional assessments of the hemiplegic patient

Am. J. Phys. Med.