Measurements of the centre of pressure of individual legs reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with post-stroke hemiplegia.
Ryo Onuma, Tadashi Masuda, Fumihiko Hoshi and 4 others
PMID 34159392WHAT IT FOUND
When people with post-stroke hemiplegia started walking, the pressure point under the paretic foot moved later in time and over a smaller distance, especially when swinging that leg first.
This may explain difficulty shifting weight onto the stance side.
Key findings
01When the paretic leg stepped first, the pressure point under that foot moved later than under the non-paretic stance foot.
02When the paretic leg was leading, the paretic foot showed a smaller peak displacement than the non-paretic foot.
03The delay in paretic-foot pressure movement was related to poorer lower-limb motor scores, poorer balance scores and slower walking.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample was small, with 30 stroke patients and 10 controls. Six stroke patients did not show posterior displacement of the paretic leg centre of pressure and were excluded from those paretic-leading analyses, so the findings do not describe that group. All participants could walk unassisted and had at least 23 points on the Mini-Mental State Examination, and people with marked leg range-of-motion limitation, ankle contracture, neglect, or other balance-affecting conditions were excluded, so this says little about more severely affected patients. This was a measurement study, not a treatment trial, so it cannot show that any therapy improves gait initiation. Foot strike patterns were not analysed, and stroke types were not equally distributed. Correlations were cross-sectional and cannot establish that centre of pressure changes cause motor, balance or walking problems.
Declared interests
The authors state that they have no conflicts of interest to declare.
The easy way to misread this
Do not conclude that exercises aimed at paretic-foot pressure timing will improve walking. This paper measured gait initiation in patients and controls and did not test any treatment.