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Persons post-stroke restore step length symmetry by walking asymmetrically

View ORCID ProfilePurnima Padmanabhan, Keerthana Sreekanth Rao, Shivam Gulhar, View ORCID ProfileKendra M. Cherry-Allen, View ORCID ProfileKristan A. Leech, View ORCID ProfileRyan T. Roemmich
doi: https://doi.org/10.1101/799775
Purnima Padmanabhan
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205
2Dept of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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  • For correspondence: rroemmi1@jhmi.edu
Keerthana Sreekanth Rao
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205
3Dept of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
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Shivam Gulhar
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205
4Virginia Commonwealth University School of Medicine, Richmond, VA 23298
5Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Kendra M. Cherry-Allen
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205
5Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Kristan A. Leech
6Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90007
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Ryan T. Roemmich
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205
5Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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  • For correspondence: rroemmi1@jhmi.edu
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ABSTRACT

Background Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the capacity to walk with symmetric step lengths (“symmetric steps”); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful?

Objective To understand how persons post-stroke generate symmetric steps and how the resulting gait pattern relates to the metabolic cost of transport.

Methods Ten persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). We recorded kinematic, kinetic, and metabolic data during both conditions.

Results Persons post-stroke restored step length symmetry using energetically expensive, asymmetric patterns. Impaired paretic propulsion and abnormal vertical movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Decreased positive paretic work correlated with increased metabolic cost of transport, decreased self-selected walking speed, and increased asymmetry in limb kinematics.

Conclusions It is important to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Facilitating symmetric steps via increased paretic propulsion or enabling paretic limb advancement without excessive vertical movement may enable persons post-stroke to walk with a less effortful, more symmetric gait pattern.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.
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Posted October 10, 2019.
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Persons post-stroke restore step length symmetry by walking asymmetrically
Purnima Padmanabhan, Keerthana Sreekanth Rao, Shivam Gulhar, Kendra M. Cherry-Allen, Kristan A. Leech, Ryan T. Roemmich
bioRxiv 799775; doi: https://doi.org/10.1101/799775
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Persons post-stroke restore step length symmetry by walking asymmetrically
Purnima Padmanabhan, Keerthana Sreekanth Rao, Shivam Gulhar, Kendra M. Cherry-Allen, Kristan A. Leech, Ryan T. Roemmich
bioRxiv 799775; doi: https://doi.org/10.1101/799775

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