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Asymmetry and Variability Should Be Included in the Assessment of Gait Function in Poststroke Hemiplegia With Independent Ambulation During Early Rehabilitation

Published:November 05, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.115

      Highlights

      • There is multicollinearity among spatiotemporal metrics of poststroke gait.
      • Principal component analysis reduced the spatiotemporal gait metrics to 3 independent components.
      • Three components are related to speed: phase, asymmetry, and variability.
      • Temporal asymmetry and variability should be assessed in poststroke gait.

      Abstract

      Objective

      To extract independent features from spatiotemporal data of poststroke gait.

      Design

      Retrospective observational study.

      Setting

      Motion analysis laboratory in the rehabilitation department of a university hospital.

      Participants

      Convenience sample from inpatients in subacute recovery stage post stroke. Of 98 patients post stroke who underwent gait assessment, 69 patients post stroke were included in the data analysis (N=69). They could walk more than 10 m without personal assist or assistive devices.

      Interventions

      Not applicable.

      Main Outcome Measures

      Spatiotemporal parameters during level walking and their asymmetry and variability were obtained by insole foot pressure measurement system.

      Results

      Of independent components extracted by principal component analysis, 3 independent components explained 81.9% of total variance of spatiotemporal poststroke gait data. The first component has associations with walking speed and proportion of double support phase, and it explains 46.6% of total variance. The second component has association with temporal asymmetry, and it explains 21.1% of total variance. The third component has association with temporal variability, and it explains 14.2% of total variance. Principal component scores did not show significant differences between stroke types and among stroke lesions.

      Conclusions

      Temporal asymmetry and variability should be included in the assessment of poststroke gait during early rehabilitation. They are independent of each other and provide characteristics of poststroke gait that are independent to the walking speed. They are helpful for rehabilitation planning and developing treatment strategy in poststroke gait rehabilitation.

      Keywords

      List of Abbreviations:

      BBS (Berg Balance Scale), MBI (Modified Barthel Index), MMSE (Mini-Mental State Examination), PC (principal component), PCA (principal component analysis), RSD (relative standard abbreviation), SI (symmetry index)
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