Journal of the Korean Society of Physical Medicine (대한물리의학회지)

The Korean Society of Physical Medicine (대한물리의학회)
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The Relationships among Gait Asymmetry, the Gait Velocity and Motor Function of Lower Extremity in Stroke Patients

뇌졸중 환자의 보행 비대칭성과 속도, 하지 운동 기능과의 상관관계

  • 남형천 (경북전문대학 물리치료과) ;
  • 김성렬 (경남대학교 물리치료학과) ;
  • 안승헌 (국립재활원 물리치료실)
  • Received : 2010.07.21
  • Accepted : 2010.08.18
  • Published : 2010.08.31
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Abstract

Purpose : The present study was to examine the difference and severity of asymmetry in independently ambulating stroke survivors and to establish the association between gait asymmetry, velocity, and the motor function of lower extremity. Methods : The subjects used in this study were 43 subjects with hemiparesis being able to walk independently. Motor function of lower extremity was measured clinically with the Fugl Meyer-Lower /Extremity Assessment. Overground gait velocity and spatia-temporal parameters were collected by the GAITRite system. Results : Thirty(69.77%) patients showed statistically significant temporal asymmetry while 28(65.1%) exhibited statistically significant spatial asymmetry. One-way ANOVA results showed a main effect of temporal asymmetry group(normative, mild, severe) for gait velocity(F=74.129), FM-L/E(F=17.270), swing-stance symmetry(F=66.869, F=13.485, respectively), spatio-temporal asymmetry(F=13.166, F=31.800, respectively) 66, F=31.800, respectively). Gait velocity was negatively associated with temporal asymmetry(r=-.83), spatial asymmetry(r=-.60). Motor function of lower extremity was also associated with temporal asymmetry(r=-.58), and spatial asymmetry(r=-.50). Conclusion : The study attempted to establish the standard assessment of hemiparesis gait symmetry in light of the complex relationship with motor impairment and gait velocity. More future work will need to link the degree of gait asymmetry to clinically relevant outcomes to better establish the clinical significance of such observations.

Keywords

References

  1. AIlet L, Leemann B, Guyen E, et al. Effect of different walking aids on walking capacity of patients with poststroke hemiparesis. Arch Phys Med Rehabil. 2009;90(8):1408-13 . https://doi.org/10.1016/j.apmr.2009.02.010
  2. Anderson TP. Rehabilitation of patient with complete stroke. In: Kottke FJ, Lehmann JF. Krusen's Handbook of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, WB Saunders Co., 1990.
  3. Bilney B, Morris M, Webster K. Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture. 2003;17(1):68-74. https://doi.org/10.1016/S0966-6362(02)00053-X
  4. Bohannon RW. Gait performance of hemiparetic stroke patients: selected variables. Arch Phys Med Rehabil. 1987;68(11):777-81.
  5. Bohaonon RW. Strength of lower limb related to gait velocity and cadence in stroke patient. Physiotherapy Canada 1986;38(4):204-6. https://doi.org/10.3138/ptc.38.4.204
  6. Brandstater ME, deBruin H, Gowland C, et al. Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil. 1983;64(12):583-7.
  7. Cohen E. Gait asymmctry and step to step variability post stroke [dissertation]. Toronto: Univ Toronto; 2004.
  8. Davis BL, Ortolano M, Richards K, et al. Realtime visual feedback diminishes energy consumption of amputee subjects during treadmill locomotion. J Prosthet Orthot. 2004;16(2):49-54. https://doi.org/10.1097/00008526-200404000-00004
  9. Draper ER. A treadmill-based system for measuring symmetry of gait. Med Eng Phys. 2000;22(3): 215-22. https://doi.org/10.1016/S1350-4533(00)00026-6
  10. Duncan PW, Propst M, Nelson SG. Reliability of the fugl-meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606-10.
  11. Fugl-Meyer AR, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. Scand J Rchabil Med. 1975;7(1):13-31.
  12. Griffin MP, Olney SJ, McBride ID. Role of symmetry in gait performance of stroke subjects with hemiplegia. Gait & Posture. 1995;3(3):132-42. https://doi.org/10.1016/0966-6362(95)99063-Q
  13. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients. standards for outcome assessment. Phys Ther. 1986;66(10): 1530-9.
  14. Hornby TG, Campbell DD, Kahn JH, et al. Enhanced gait-related improvement after therapist-versus robotic-assisted locomotor training in subject with chronic stroke: A Randomized Controlled Study. Stroke. 2008;39(11):1786-92.
  15. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84(8):1185-93. https://doi.org/10.1016/S0003-9993(03)00030-3
  16. Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait & Posture. 2003;18(1): 23-8. https://doi.org/10.1016/S0966-6362(02)00122-4
  17. Lin P, Yang Y, Cheng S, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-8. https://doi.org/10.1016/j.apmr.2005.12.042
  18. Lord SE, McPherson K, McNaughton HK, et al. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil. 2004;85 (2):234-9. https://doi.org/10.1016/j.apmr.2003.05.002
  19. McDonough AL, Batavia M, Chen FC, et al. The validity and reliability of the GAITRite system's measurements: a preliminary evaluation. Arch Phys Med Rehabil. 2001;82(3):419-25. https://doi.org/10.1053/apmr.2001.19778
  20. Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait and cardiovascular fitness. Arch Phys Med Rehabil. 2005;86(8): 1552-6. https://doi.org/10.1016/j.apmr.2004.12.026
  21. Nadeau S, Aresemault AB, Gravel D, et al. Analysis to the clinical factors determinating natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil. 1999;78(2):123-30. https://doi.org/10.1097/00002060-199903000-00007
  22. Olney SJ, Griffin MP, McBride ID. Temporal, kinematic and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther 1994;74(9):872-85.
  23. Patterson KK. Characteristics of independent ambulation in chronic stroke survivors. [dissertation]. Toronto: Univ Toronto. 2006.
  24. Patterson KK, Parafianowicz I, Danells CJ, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil 2008;89(2): 304-10. https://doi.org/10.1016/j.apmr.2007.08.142
  25. Perry J, Garrett M, Gronley JK, et al. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-9. https://doi.org/10.1161/01.STR.26.6.982
  26. Platts MM, Rafferty D, Paul L. Metabolic cost of overground gait in younger stroke patients and healthy controls. Med Sci Sports Exerc. 2006;38 (6):1041-6. https://doi.org/10.1249/01.mss.0000222829.34111.9c
  27. Roth EJ, Merbitz C, Mroczek K, et al. Hemiplegic gait: relationships between walking speed and other temporal parameters. Am J Phys Med Rehabil. 1997;76(2):128-33. https://doi.org/10.1097/00002060-199703000-00008
  28. Taylor D, Stretton CM, Mudge S, et al. Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke? Clin Rehabil. 2006;20(5):438-44. https://doi.org/10.1191/0269215506cr945oa
  29. Wall JC, Tumbull GI. Gait asymmetries in residual hemiplegia. Arch Phys Med Rehabil. 1986;67(8): 550-3.
  30. Yan T, Hui-Chan CW, Li LS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke. 2005;36(1):80-5. https://doi.org/10.1161/01.STR.0000149623.24906.63