Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors

Arch Phys Med Rehabil. 2019 Jun;100(6):1091-1101. doi: 10.1016/j.apmr.2018.10.014. Epub 2018 Nov 14.


Objective: To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function.

Design: Cohort study.

Setting: Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital.

Participants: Consecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100).

Interventions: Not applicable.

Main outcome measures: Gait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients.

Results: Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004).

Conclusions: Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.

Keywords: Hamstring muscles; Muscle strength; Neurologic gait disorders; Rehabilitation; Stroke rehabilitation; Walking speed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Gait
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / physiopathology*
  • Humans
  • Lower Extremity
  • Male
  • Middle Aged
  • Muscle Strength
  • Muscle Weakness / etiology*
  • Muscle Weakness / physiopathology*
  • Muscle, Skeletal / physiopathology*
  • Paresis / etiology
  • Paresis / physiopathology*
  • Stroke / complications*
  • Time Factors
  • Walking Speed