Gait Impairments in Patients without Lower Limb Hypertonia Early after Stroke are Related to Weakness of Paretic Knee Flexors

Publication date: Available online 14 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): John W. Chow, Dobrivoje S. Stokic

Abstract

Objective

To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function.

Design

Cohort study.

Setting

Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital.

Participants

Consecutive sample of 73 eligible inpatients (first-known stroke <2 months post-onset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls.

Interventions

Not applicable.

Main Outcome Measures

Gait speed, stride/step length and cadence, stance time, single/double support time, and associated symmetry measures in patients at self-selected normal speed and controls at very-slow speed (51.1±32.6 and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion/extension strength in patients.

Results

Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than non-paretic limb. Most temporospatial parameters moderately-to-strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004).

Conclusions

Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early after stroke.

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