Tempo-spatial gait adaptations in stroke patients when approaching and crossing an elevated surface

Area of Science:

• Neuroscience
• Biomechanics
• Rehabilitation Science

Background:

• Outdoor walking is crucial for community participation in ambulatory stroke survivors.
• Adapting to environmental height changes, like curbs, requires precise motor control and balance, which are often impaired after stroke.

Purpose of the Study:

• To investigate how stroke patients approach and step onto elevated surfaces.
• To compare gait adaptations in stroke survivors versus healthy controls when encountering a 15cm elevation.

Main Methods:

• Gait analysis using sensor carpets and 3D motion capture compared 12 hemiparetic stroke patients and 13 controls.
• Evaluated tempo-spatial parameters and foot trajectories during level walking and stepping onto an elevation.
• Assessed balance, gait index, and fear of falling using standardized clinical tests.

Main Results:

• Stroke patients exhibited poorer balance, higher fear of falling, and slower approaches with shorter steps compared to controls.
• While leading leg clearance was not reduced, patients landed closer to the edge, with less clearance for the paretic leg, increasing tripping risk.
• Slower walking speeds complicated safe foot placement and leg clearance, whereas better balance correlated with safer limb advancement.

Conclusions:

• Leading with the paretic leg presents challenges in leg clearance when stepping onto elevated surfaces, influenced by walking speed.
• Therapeutic strategies should consider that slower walking may not enhance safety; faster gait and improved postural control may facilitate curb negotiation in stroke survivors.