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Biomechanical and strength factors contributing to walking performance in persons with stroke Kim, Chin-Ah Maria


Purpose: The most often stated goal by persons with stroke is improved walking function, therefore it is important to understand the biomechanical mechanisms of gait and the factors that may improve its performance. The purpose of this study was to 1) describe three-dimensional (3-D) gait patterns, 2) examine the relationship between gait speed and kinematic/kinetic variables and 3) determine the effect of maximal strength training on walking performance, in addition to muscle strength and health-related quality of life, in chronic stroke survivors. Methods: Twenty individuals with chronic stroke (61.2 ± 8.4 years) were randomized into two six week (three times a week) training programs on the basis of age, sex, and time since onset of stroke (stratified randomization). An optoelectronic system and forceplates were used to generate 3-D kinematic and kinetic profiles during walking. The experimental group undertook maximal concentric isokinetic strength training o f the paretic lower limb flexors and extensors with the use of the Kin-Corn dynamometer. The control group received passive range of motion exercises using the same instrument. The Mann-Whitney LTest was used to compare the changes in score (posttraining-baseline) between the control and experimental groups: composite lower extremity strength score, walking speed (level and stair-walking) and health-related quality of life measure (SF-36). Correlations were used to assess the relationship between gait speed and biomechanical gait variables. Results: Twenty-five kinematic and twenty-five kinetic patterns were identified across three joints (hip, knee, ankle), three planes and two sides among the 20 participants. Kinetic, more so than kinematic variables were correlated with gait speed, particularly in the sagittal and frontal planes for both the paretic and non-paretic sides. No differences in the change of walking speed or SF-36 scores was found between groups despite the trend (p = 0.06) towards greater strength improvement in the experimental group following training. Conclusions: Strength training of the flexors/extensors of the paretic limb did not result in improvements in walking performance or health-related quality of life. The results of the biomechanical gait analysis suggest that in addition to these muscle groups, training programs that include hip abductors and the non-paretic limb may improve gait performance.

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