Article

In hemiplegic gait, step length typically differs in magnitude
between paretic and nonparetic sides. However, the direction of step-length
asymmetry varies across stroke patients. OBJECTIVE:
The study sought to
understand directional variations in step-length asymmetry in terms of asymmetries in forward foot placement relative to the trunk and trunk
progression. METHODS: A total of 10 hemiplegic stroke patients and 9 healthy
elderly controls walked at a self-selected comfortable speed while pelvic and
heel marker positions were recorded. Step length, forward foot placement relative
to the trunk, and trunk progression of paretic and nonparetic steps were
quantified, as well as the asymmetries therein. RESULTS: The 3 asymmetry indices
in question varied within individual patients and occasionally fell within
control reference ranges, whereas directional variations across stroke patients
were observed for asymmetries in step length and forward foot placement only.
Despite heterogeneity in asymmetry across patients,
step-length asymmetry was
determined by the sum of asymmetries in forward foot placement and trunk
progression. Asymmetries in trunk progression and forward foot placement were
negatively correlated. No significant association was observed between
step-length asymmetry and any other asymmetry index. CONCLUSIONS: Step-length
asymmetry was accounted for
by asymmetries in forward foot placement and trunk
progression, whereas their relative contribution accounted for directional
variations in step-length asymmetry. Partitioning of step-length asymmetry
further helped to identify individual impairments and compensatory gait
strategies. An encompassing hemiplegic gait evaluation should therefore include
an assessment of foot positioning relative to the trunk.

Langue : ANGLAIS