Symmetrical kinematic changes in highly functioning older patients post-stroke during obstacle-crossing

Abstract

With the advances in stroke care, the number of high-functioning patients after stroke is increasing. However, existing clinical tools may not be sensitive enough to identify the residual deficits in these patients. The current study aimed to investigate the control of the pelvis, and the joints and end-point of the lower limbs in high-functioning older patients post-stroke during obstacle-crossing using motion analysis techniques. Twenty-four high-functioning older patients following unilateral stroke and fifteen healthy controls walked and crossed obstacles of three different heights. End-point variables (leading toe-clearance and trailing toe-obstacle distance) and crossing pelvic and joint angles were obtained for both limbs during leading limb crossing. Whether leading with the contralesional or ipsilesional limb, the stroke group exhibited significantly different joint kinematics from the controls mainly in the frontal and transverse planes, with greater leading toe-clearance, trailing toe-obstacle distance, and posterior pelvic tilt. None of the end-point and joint variables were significantly different between limbs. High-functioning patients post-stroke appeared to have acquired a specific symmetric kinematic strategy with increased leading toe-clearance during obstacle-crossing, most likely in order to prevent tripping. This symmetric strategy, possibly a consequence of brain reorganization, may help in performing functional activities during which symmetric performance between the contralesional and ipsilesional sides is required. Obstacle-crossing training with both limbs leading alternately may be helpful for the development of this symmetric strategy. It is suggested that computerized motion analysis of obstacle-crossing can be a sensitive assessment tool for distinguishing the motor performance between normal and high-functioning patients post-stroke.