Persons post-stroke improve step length symmetry by walking asymmetrically.
Purnima Padmanabhan, Keerthana Sreekanth Rao, Shivam Gulhar and 3 others
PMID 32746886WHAT IT FOUND
Energy cost did not change when nine persons post-stroke used visual feedback to make step lengths symmetric.
They did it by keeping asymmetric limb mechanics and impaired paretic propulsion, so symmetry alone may not improve walking effort.
Key findings
01During the symmetric stepping trial, participants reduced step length asymmetry by lengthening the shorter step and shortening the longer step, but net cost of transport did not change.
02Kinematic asymmetry did not significantly decrease during symmetric stepping and remained associated with cost of transport in both conditions.
03Positive paretic work correlated with lower cost of transport and faster walking, while positive nonparetic work did not.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only nine analysed participants, all chronic post-stroke with mild-to-moderate gait dysfunction, so results may not apply to more impaired or acute patients. One excluded participant reduced asymmetry below 2 cm on treadmill, so the sample was selected for persistent asymmetry. This was a single testing session, not a training programme, so it cannot show long-term improvement in walking or energy cost. Seven participants held handrails, two wore ankle-foot orthoses, and one used functional electrical stimulation, and handrail effects were not quantified. Symmetric stepping was achieved only by visual targets and instructions to hit the same target with each pair of steps, so other ways of restoring symmetry may have different mechanics. Correlations do not prove that paretic work caused cost of transport or walking speed.
Declared interests
The supplied text names National Institute on Aging as funder and does not report other conflicts.
The easy way to misread this
Do not conclude that making step lengths symmetric improves walking energy. In this nine-person single-session lab study, symmetry improved but cost of transport did not change. Participants kept asymmetric mechanics, and some also used handrails, orthoses, or electrical stimulation.