Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke

Abstract

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).

Findings: 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.

Interpretation: 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.

Keywords: Circumduction; Gait; Kinematics; Stroke.

Figure 1

Average peak joint angles during swing phase of the paretic limb across all self-selected walking speeds for (a) ankle dorsiflexion, (b) knee flexion, (c) pelvic tilt, and (d) hip abduction. Vertical lines at 0.4 and 0.8 m/s represent speed divisions between ambulation categories determined by Perry et al.