Spatial asymmetry of post-stroke hemiparetic gait: assessment and recommendations for physical rehabilitation

Background: Asymmetry of various bilateral gait parameters is an important characteristic of quality of post-stroke hemiparetic gait. Persistent gait asymmetry has a negative impact on energy cost of locomotion, balance control, muscular-skeletal health and activity level of hemiparetic patients and, therefore, it needs to be addressed during rehabilitation post-stroke. Despite potential benefits, quantitative analysis of gait asymmetry is still not routinely used in many hospitals and rehabilitation institutions in developing countries due to the high cost involved in setting a gait laboratory. The objective of this study was to evaluate the potential of the footprint and Symmetry Index (SI) methods for the assessment of gait asymmetry in hemiparetic post-stroke patients with the goal of achieving recommendations regarding physical rehabilitation.
Methods: The study was conducted at the Queen Elizabeth Central Hospital, Blantyre, Malawi. A total of 36 post-stroke patients who had survived six months or more after a unilateral stroke participated in the study. The non-disabled control group was matched with the hemiparetic group by age, sex and anthropometric characteristics. Step length and foot rotation angle of the participants were recorded using the footprint method.
Results: Results showed that steps on the paretic side were significantly longer and foot rotation angle was wider than those on the non-paretic side (p<0.005 and p<0.01, respectively). Compare to the controls, patients had significantly shorter steps on both sides (p<0.05 and p<0.001, respectively) while the values of foot rotation angle were only higher on the affected side (p<0.001). The mean values of step length and foot rotation angle SI in the patients were significantly higher than in the controls (p<0.001). Based on the magnitude of the SI, most of post-stroke patients were classified as asymmetric.
Conclusion: Overall, the study demonstrated asymmetry of step length and foot rotation angle during walking of post-stroke hemiparetic individuals and highlighted the potential of the footprint and SI methods as objective and easy to apply tools suitable for the assessment of symmetry of spatial gait parameters in clinical and rehabilitation settings. The results also emphasized the need for rehabilitation interventions designed specifically to improve the spatial symmetry of post-stroke hemiparetic gait.