Identifying impairments and compensatory strategies for temporal gait asymmetry in post-stroke persons

In post-stroke persons, temporal gait asymmetry (TGA) during comfortable gait involves a combination of pure impairments and compensatory strategies. In this study, we aimed to differentiate between pure impairments and compensatory strategies underlying TGA in post-stroke individuals and identify associated clinical factors. We examined 39 post-stroke individuals who participated in comfortable walking speed (CWS) and rhythmic auditory cueing (RAC). Gait evaluation included spatiotemporal parameters and trunk acceleration, while clinical evaluation comprised motor paralysis severity, sensory disturbances, spasticity, balance ability, and gait efficacy. The participants were classified by clustering based on the symmetry index during CWS and RAC. TGA during CWS or RAC gait showed no association (ρ = 0.062, p = 0.707). Clustering yielded four optimal clusters. Cluster 1 was asymmetric during CWS but symmetric during RAC condition (over-compensatory strategies); these participants had a poor score on the modified gait efficacy scale, and despite mild functional impairments, they lacked the confidence to walk safely. Cluster 2 showed impairment-driven asymmetry during CWS and RAC, with severe impairments and instability. Participants showing improved TGA under auditory cueing compared with comfortable speed demonstrate strong compensatory strategies associated with low gait efficacy. This suggests a need for targeted interventions to enhance gait self-efficacy and maximize residual function.