Gait asymmetry pattern following stroke determines acute response to locomotor task.
Virginia L Little, Lindsay A Perry, Mae W V Mercado and 2 others
PMID 32126493WHAT IT FOUND
Stroke survivors with different step-length asymmetries responded differently to treadmill walking, body-weight support, and guidance of the less affected leg.
The first two did not improve symmetry. Guidance sometimes improved timing or step length, but effects varied.
Key findings
01For people with a shorter paretic step, none of the treadmill conditions significantly changed step-length symmetry.
02For people with symmetrical step lengths, guiding the less affected leg made step timing symmetrical but made step lengths asymmetrical.
03For people with a shorter nonparetic step, guiding the less affected leg appeared to make step lengths symmetrical, but the change did not reach adjusted significance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 39 participants were studied, and the asymmetry groups were small, so the subgroup findings may not apply broadly. The study tested single, short treadmill exposures of up to 40 seconds, not repeated locomotor training, so it cannot show treatment benefit. Participants had to walk at least 10 meters independently, with or without an ankle-foot orthosis or assistive device, so more impaired stroke survivors were not represented. Handrails, assistive devices, and ankle-foot orthoses were removed during testing, which may not match usual clinical walking. Several statistical tests were adjusted for multiple comparisons, and some apparent improvements did not reach significance. The study measured acute biomechanical symmetry, not energy cost, falls, or patient function.
Declared interests
The authors declared no conflicts of interest. The publication types indicate NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that locomotor training improves gait symmetry after stroke. These were single acute treadmill conditions, not a treatment programme, and the strongest symmetry changes were subgroup-specific and sometimes not statistically significant.