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Nedergård H1, Johansson G1, Häger CK1
1Umeå University, Community Medicine and Rehabilitation, Umeå, Sweden
Background: Three-dimensional post-stroke gait analysis is typically based on kinematic spatial and temporal parameters like e.g. gait speed, step length and stride width. However, there is a lack of evidence regarding how well such variables reflect gait quality and multi-joint coordination patterns, or how body symmetry should be evaluated. Moreover, these analyses most often focus only on leg movements, neglecting possible influences from the trunk and upper extremities. We aimed to disentangle the interrelationship in such gait-related variables.
Purpose: To investigate how post-stroke spatial and temporal gait parameters relate to kinematic scores summarizing joint movement deviations in upper and lower extremities, and to the mediolateral centre-of-mass position, respectively, as compared to the gait of healthy persons.
Methods: Thirty-one persons post-stroke and forty-one age-matched healthy persons walked at their self-selected speed while an eight-camera motion capture system (240 Hz; Qualisys AB; Sweden) registered kinematic data. Data were processed using Visual 3D (C-motion Inc., US) to compute common spatial and temporal parameters. Temporal asymmetry was analysed using the stance time ratio between the affected and non-affected side. Overall movement deviations from healthy persons in the upper and lower extremities were quantified using the Arm Posture Score (APS) and the Gait Profile Scale (GPS), respectively. The mediolateral centre-of-mass position was detected with the mediolateral centre-of-mass ankle inclination angle (MCoM-aIA) during stance phase, defined as the mediolateral angle between the centre of mass and the centre point between the medial and lateral malleolus. The values and scores for the affected side of the body were used for correlation analysis with Spearman´s rho (rs).
Results: Preliminary analyses showed that gait speed was highly correlated with GPS (rs=0.782, p=0.000), and moderately correlated with APS (rs=0,545, p=0,002) as well as with the MCoM-aIA (rs=0.659, p=0.000) in persons post-stroke. Step length was also highly correlated with GPS (rs=0.732, p=0,000), while moderately correlated with APS (rs=0.601, p=0.000) and with MCoM-aIA (rs=0.611, p=0.000). Stride width showed low correlation with the three variables (rsAPS=0.456, p=0.010; rsGPS=0.400, p=0.026; rsMCoM-aIA=0.413, p=0.021), while temporal asymmetry was not significantly correlated with GPS but showed low correlation with APS (rs=0.460, p=0.009) and with the MCoM-aIA (rs=0.453, p=0.011). No significant correlations between the variables of interest were detected in healthy persons.
Conclusion(s): Assessments of gait speed, step length and stride width during three-dimensional gait analysis reflect the degree of deviations in upper and lower extremity joint movements as well as the mediolateral centre-of-mass position of persons post-stroke when compared to healthy persons. Upper extremity deviations and the mediolateral centre-of-mass position, but not lower extremity movement deviations, were correlated with temporal asymmetry during gait.
Implications: Our results imply that post-stroke gait quality assessment should not be limited only to lower extremity movement deviations but should encompass a whole-body perspective. Further analyses should more in detail determine how the variables applied in our study interact with each other as the body strives to overcome neuromuscular deficits and challenges during post-stroke gait and how this relates to movement quality.
Keywords: Motion analysis, body symmetry, kinematics
Funding acknowledgements: The Swedish Brain Foundation, Umeå University, Västerbotten County Council
Purpose: To investigate how post-stroke spatial and temporal gait parameters relate to kinematic scores summarizing joint movement deviations in upper and lower extremities, and to the mediolateral centre-of-mass position, respectively, as compared to the gait of healthy persons.
Methods: Thirty-one persons post-stroke and forty-one age-matched healthy persons walked at their self-selected speed while an eight-camera motion capture system (240 Hz; Qualisys AB; Sweden) registered kinematic data. Data were processed using Visual 3D (C-motion Inc., US) to compute common spatial and temporal parameters. Temporal asymmetry was analysed using the stance time ratio between the affected and non-affected side. Overall movement deviations from healthy persons in the upper and lower extremities were quantified using the Arm Posture Score (APS) and the Gait Profile Scale (GPS), respectively. The mediolateral centre-of-mass position was detected with the mediolateral centre-of-mass ankle inclination angle (MCoM-aIA) during stance phase, defined as the mediolateral angle between the centre of mass and the centre point between the medial and lateral malleolus. The values and scores for the affected side of the body were used for correlation analysis with Spearman´s rho (rs).
Results: Preliminary analyses showed that gait speed was highly correlated with GPS (rs=0.782, p=0.000), and moderately correlated with APS (rs=0,545, p=0,002) as well as with the MCoM-aIA (rs=0.659, p=0.000) in persons post-stroke. Step length was also highly correlated with GPS (rs=0.732, p=0,000), while moderately correlated with APS (rs=0.601, p=0.000) and with MCoM-aIA (rs=0.611, p=0.000). Stride width showed low correlation with the three variables (rsAPS=0.456, p=0.010; rsGPS=0.400, p=0.026; rsMCoM-aIA=0.413, p=0.021), while temporal asymmetry was not significantly correlated with GPS but showed low correlation with APS (rs=0.460, p=0.009) and with the MCoM-aIA (rs=0.453, p=0.011). No significant correlations between the variables of interest were detected in healthy persons.
Conclusion(s): Assessments of gait speed, step length and stride width during three-dimensional gait analysis reflect the degree of deviations in upper and lower extremity joint movements as well as the mediolateral centre-of-mass position of persons post-stroke when compared to healthy persons. Upper extremity deviations and the mediolateral centre-of-mass position, but not lower extremity movement deviations, were correlated with temporal asymmetry during gait.
Implications: Our results imply that post-stroke gait quality assessment should not be limited only to lower extremity movement deviations but should encompass a whole-body perspective. Further analyses should more in detail determine how the variables applied in our study interact with each other as the body strives to overcome neuromuscular deficits and challenges during post-stroke gait and how this relates to movement quality.
Keywords: Motion analysis, body symmetry, kinematics
Funding acknowledgements: The Swedish Brain Foundation, Umeå University, Västerbotten County Council
Topic: Neurology; Human movement analysis
Ethics approval required: Yes
Institution: Umeå University
Ethics committee: The Regional Ethical Review Board in Umeå
Ethics number: 2011-199-31
All authors, affiliations and abstracts have been published as submitted.
