Stabilometry is a predictor of gait performance in chronic hemiparetic stroke patients.

In patients with spastic hemiparesis, centre of foot pressure (CoP) is shifted toward the unaffected limb during quiet stance. We hypothesised that abnormal gait features would correlate with the degree of asymmetry during stance. In 15 patients and 17 normals we recorded CoP and body sway by a force platform and measured spatial-temporal variables of gait with pedobarography. In patients CoP was shifted toward the unaffected limb and sway was larger than in normals. CoP position was associated with the decrease in strength of the affected lower-limb muscles. Spatio-temporal variables of gait were also affected by the disease. Cadence and velocity were decreased, duration of single support on the unaffected limb and of double support were increased with respect to normals. The degree of impairment of gait variables correlated with CoP. We found a negative relationship between velocity or cadence and CoP, and a positive relationship between duration of single support and CoP in the unaffected but not in the affected limb. Duration of double support correlated positively with CoP. CoP asymmetry during both standing and walking suggests that postural and gait problems share some common neural origin in hemiparetic patients. This asymmetry affects gait performance by increasing the time and effort needed to shift body weight toward the affected limb. The degree of postural asymmetry measured by stabilometry is associated with the level of impairment of gait variables.

[1]  D. Winter,et al.  Unified theory regarding A/P and M/L balance in quiet stance. , 1996, Journal of neurophysiology.

[2]  J. Marsden,et al.  The vestibular control of balance after stroke , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[3]  Marco Schieppati,et al.  Group II spindle fibres and afferent control of stance. Clues from diabetic neuropathy , 2004, Clinical Neurophysiology.

[4]  T. Sinkjaer,et al.  Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke. , 2007, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[5]  H. Kurogo,et al.  Determinants and predictors of the maximum walking speed during computer-assisted gait training in hemiparetic stroke patients. , 1999, Archives of physical medicine and rehabilitation.

[6]  M. Schieppati,et al.  Unilateral displacement of lower limb evokes bilateral EMG responses in leg and foot muscles in standing humans , 1996, Experimental Brain Research.

[7]  P. Morasso,et al.  Body sway during quiet standing: is it the residual chattering of an intermittent stabilization process? , 2005, Human movement science.

[8]  D. Winter,et al.  Biomechanical walking pattern changes in the fit and healthy elderly. , 1990, Physical therapy.

[9]  D. Marigold,et al.  The relationship of asymmetric weight-bearing with postural sway and visual reliance in stroke. , 2006, Gait & posture.

[10]  J. Eng,et al.  Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. , 2002, Archives of physical medicine and rehabilitation.

[11]  S. Nadeau,et al.  Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. , 1999, Clinical biomechanics.

[12]  M. Schieppati,et al.  Reflex contribution of spindle group Ia and II afferent input to leg muscle spasticity as revealed by tendon vibration in hemiparesis , 2005, Clinical Neurophysiology.

[13]  S Corna,et al.  Selective depression of medium‐latency leg and foot muscle responses to stretch by an alpha 2‐agonist in humans. , 1995, The Journal of physiology.

[14]  I. Tarkka,et al.  Footprint analysis of gait using a pressure sensor system. , 2004, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[15]  J. Rothwell,et al.  Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? , 2008, Brain : a journal of neurology.

[16]  Annie A Butler,et al.  Muscle weakness impairs the proprioceptive control of human standing , 2008, Brain Research.

[17]  P. Morasso,et al.  Can muscle stiffness alone stabilize upright standing? , 1999, Journal of neurophysiology.

[18]  Richard W. Bohannon Is the measurement of muscle strength appropriate in patients with brain lesions? A special communication. , 1989, Physical therapy.

[19]  A. Thilmann,et al.  Pathological stretch reflexes on the "good" side of hemiparetic patients. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[20]  D. Pérennou,et al.  Contribution of Each Lower Limb to Upright Standing in Stroke Patients , 2008, Stroke.

[21]  P. Tang,et al.  Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. , 2003, Archives of physical medicine and rehabilitation.

[22]  C. Gowland,et al.  Hemiplegic gait: analysis of temporal variables. , 1983, Archives of physical medicine and rehabilitation.

[23]  M. Schieppati,et al.  Stance control is not affected by paresis and reflex hyperexcitability: the case of spastic patients , 2001, Journal of neurology, neurosurgery, and psychiatry.

[24]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[25]  S. M. Morton,et al.  Relative contributions of balance and voluntary leg-coordination deficits to cerebellar gait ataxia. , 2003, Journal of neurophysiology.

[26]  J. Eng,et al.  The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. , 2003, Physical therapy.

[27]  Ari Pääkkönen,et al.  Gait Characteristics and Functional Ambulation Profile in Patients with Chronic Unilateral Stroke , 2003, American journal of physical medicine & rehabilitation.

[28]  Titianova Eb,et al.  Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. , 1995 .

[29]  Alain Delarque,et al.  Evaluation of patients with gait abnormalities in physical and rehabilitation medicine settings. , 2008, Journal of rehabilitation medicine.

[30]  F. Zajac,et al.  Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. , 2005, Gait & posture.

[31]  J C Wall,et al.  Gait asymmetries in residual hemiplegia. , 1986, Archives of physical medicine and rehabilitation.

[32]  P. Goldie,et al.  Maximum voluntary weight-bearing by the affected and unaffected legs in standing following stroke. , 1996, Clinical biomechanics.

[33]  V. Dietz,et al.  Locomotor activity in spinal man: significance of afferent input from joint and load receptors. , 2002, Brain : a journal of neurology.

[34]  F. Lacquaniti,et al.  Interactions between posture and locomotion: motor patterns in humans walking with bent posture versus erect posture. , 2000, Journal of neurophysiology.

[35]  J. Collins,et al.  Open-loop and closed-loop control of posture: A random-walk analysis of center-of-pressure trajectories , 2004, Experimental Brain Research.

[36]  Mary Rodgers,et al.  Bilateral foot center of pressure measures predict hemiparetic gait velocity. , 2006, Gait & posture.

[37]  R W Bohannon,et al.  Gait performance of hemiparetic stroke patients: selected variables. , 1987, Archives of physical medicine and rehabilitation.

[38]  Subashan Perera,et al.  Improvements in Speed-Based Gait Classifications Are Meaningful , 2007, Stroke.