Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke
Abstract Background Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumpt...
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BMC
2025-01-01
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| Series: | Journal of NeuroEngineering and Rehabilitation |
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| Online Access: | https://doi.org/10.1186/s12984-025-01553-8 |
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| author | Sarah A. Kettlety James M. Finley Kristan A. Leech |
| author_facet | Sarah A. Kettlety James M. Finley Kristan A. Leech |
| author_sort | Sarah A. Kettlety |
| collection | DOAJ |
| description | Abstract Background Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry in individuals post-stroke, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM. Methods. Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude (Δ|PA|) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ|PA|. Results. We found a positive association between Δ|PA| and ΔCGAM (β = 2.6, p = 0.002). The average Δ|PA| was -0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value. Conclusions. Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry. Clinical Trial Registration. NCT04411303. |
| format | Article |
| id | doaj-art-08288349368542a99af22ee02f198c8c |
| institution | Kabale University |
| issn | 1743-0003 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj-art-08288349368542a99af22ee02f198c8c2025-01-26T12:18:38ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032025-01-0122111010.1186/s12984-025-01553-8Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-strokeSarah A. Kettlety0James M. Finley1Kristan A. Leech2Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaDivision of Biokinesiology and Physical Therapy, University of Southern CaliforniaDivision of Biokinesiology and Physical Therapy, University of Southern CaliforniaAbstract Background Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry in individuals post-stroke, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM. Methods. Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude (Δ|PA|) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ|PA|. Results. We found a positive association between Δ|PA| and ΔCGAM (β = 2.6, p = 0.002). The average Δ|PA| was -0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value. Conclusions. Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry. Clinical Trial Registration. NCT04411303.https://doi.org/10.1186/s12984-025-01553-8StrokePropulsionAsymmetryWalkingCombined gait asymmetry metric |
| spellingShingle | Sarah A. Kettlety James M. Finley Kristan A. Leech Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke Journal of NeuroEngineering and Rehabilitation Stroke Propulsion Asymmetry Walking Combined gait asymmetry metric |
| title | Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke |
| title_full | Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke |
| title_fullStr | Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke |
| title_full_unstemmed | Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke |
| title_short | Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke |
| title_sort | within session propulsion asymmetry changes have a limited effect on gait asymmetry post stroke |
| topic | Stroke Propulsion Asymmetry Walking Combined gait asymmetry metric |
| url | https://doi.org/10.1186/s12984-025-01553-8 |
| work_keys_str_mv | AT sarahakettlety withinsessionpropulsionasymmetrychangeshavealimitedeffectongaitasymmetrypoststroke AT jamesmfinley withinsessionpropulsionasymmetrychangeshavealimitedeffectongaitasymmetrypoststroke AT kristanaleech withinsessionpropulsionasymmetrychangeshavealimitedeffectongaitasymmetrypoststroke |