Monitoring walking asymmetries and endpoint control in persons living with chronic stroke: Implications for remote diagnosis and telerehabilitation

Abstract

Objective: The objective of this study was to assess the feasibility of monitoring and diagnosing compromised walking motion in the frontal plane, particularly in persons living with the chronic effects of stroke (PwCS). The study aimed to determine whether active control of walking in the frontal plane could be monitored and provide diagnostic insights into compensations made by PwCS during community living.

Methods: The study recruited PwCS with noticeable walking asymmetries and employed a monitoring method to assess frontal plane motion. Monitoring was conducted both within a single assessment and between assessments. The study aimed to uncover baseline data and diagnostic information about active control in chronic stroke survivors. Data were collected using sensors during 6 minutes of walking and compared between the paretic and non-paretic legs.

Results: The study demonstrated the feasibility of monitoring frontal plane motion and diagnosing disturbed endpoint control (p < 0.0125) in chronic stroke survivors when comparing the paretic leg to the non-paretic leg. A greater variability was observed in the paretic leg (p < 0.0125), and sensors were able to diagnose a stronger coupling of the body with its endpoint on the paretic side (p < 0.0125). Similar results were obtained when monitoring was conducted over a six-minute walking period, and no significant diagnostic differences were found between the two monitoring assessments. Monitoring did not reveal performance fatigue or debilitation over time.

Conclusions: This study's findings indicate that monitoring frontal plane motion is a feasible approach for diagnosing compromised walking motion. The results suggest that individuals with walking asymmetries, exhibit differences in endpoint control and variability between their paretic and non-paretic legs. These insights could contribute to more effective rehabilitation strategies and highlight the potential for monitoring compensations during various activities of daily living.

Keywords: Walking; endpoint control; pelvic coupling; rehabilitation; stroke.

Figure 1.

Mediolateral displacement (MLD) results were displayed for both legs displaying the results over time with each panel containing the data for each successive 30-second time period over the six-minute walk. MLD was greater in the affected leg (red) compared to the unaffected leg (blue). The shaded portions of the fitted lines show the confidence intervals.

Figure 2.

The mediolateral displacement standard deviation (SDMLD) results were displayed for both legs (left) with the subjects’ data binned and arranged in order of slower to faster walking speeds. SDMLD was greater in the affected leg (red) compared to the unaffected leg (blue). The affected leg significantly increased its displacement with increasing speed (right), while the unaffected leg had negligible increases with increasing speed. The shaded portion of the fitted lines shows the confidence regions.

Figure 3.

The top panel displays the cross-correlation (xCorr) results over time for each successive 30-second time section over the six-minute walk, and the bottom panel displays the xCorr results. xCorr was stronger on the affected side (red, dashed line) while tLag was shorter for the affected side. The shaded portion of the fitted lines shows the confidence intervals.