Kinematic Biomarkers of Limb Shortening and Compensations in Hemiparetic Gait: A Systematic Review

Abstract

Background: Hemiparetic gait is characterized by reduced limb shortening during swing, increasing the risk of tripping and leading to compensatory strategies. Despite 3D gait analysis being the gold standard for gait assessment, there is no consensus on relevant kinematic biomarkers for limb shortening and compensatory movements.

Methods: Systematic review querying five databases (PubMed, Cochrane, Scopus, PEDro, and Web of Science). We included articles that described at least one kinematic biomarker of the lower limb in the sagittal plane and at least one biomarker of the lower limb or pelvis in the transversal or frontal plane, or pelvis in the sagittal plane. Then, we collected kinematic biomarkers from these studies and identified those that seemed relevant to describe limb shortening and compensatory movements during the swing phase.

Results: We included 40 studies and collected 385 biomarkers. Among them, 15 described limb shortening, 22 compensations, and 3 toe clearance. Analysis of 12 interventional studies showed that some biomarkers of shortening and compensation were more sensitive to change than others.

Conclusions: This review highlights the lack of standardized description for limb shortening and compensatory movements in hemiparetic gait. A set of 13 relevant biomarkers is proposed to improve the interpretation of gait analysis and support consistent evaluation of therapeutic interventions.

Keywords: compensatory movements; gait analysis; hemiplegia; limb shortening; toe clearance.

Figure 3

Circos-plot linking the included studies with their relevant kinematic biomarkers for limb shortening and compensatory movement description. Biomarkers are displayed in the upper part of the figure: limb-shortening biomarkers are shown on the left in blue-green, compensatory movement biomarkers on the right in yellow-orange, and clearance-related biomarkers in the centre in purple. The studies using these biomarkers are listed in the lower part of the figure. The number of relevant biomarkers per study and the number of times each biomarker was used are reported in black for each study or biomarker, respectively. The list of biomarker abbreviations is available in Table 2.

Figure 1

PRISMA flowchart of studies’ selection process.

Figure 2

Flow chart of biomarkers’ selection process. Biomarkers related to limb shortening are outlined in blue-green, those reflecting compensatory movements in red-orange, and those associated with toe clearance in purple.