Simulation and experimental analyses to assess walking performance post-stroke using step length asymmetry and module composition

Understanding the underlying coordination mechanisms that lead to a patient’s poor walking performance is critical in developing effective rehabilitation interventions. However, most common measures of rehabilitation effectiveness do not provide information regarding underlying coordination mechanisms. The overall goal of this research was to analyze the relationship between two potential measures of walking performance (step length asymmetry and module composition) and underlying walking mechanics.

Experimental analyses were used to analyze the walking mechanics of hemiparetic subjects grouped by step length asymmetry. All groups had impaired plantarflexor function and the direction of asymmetry provided information regarding the compensatory mechanism used to overcome this plantarflexor impairment. Those subjects who walked with longer paretic than nonparetic steps compensated using increased output from the nonparetic leg, while those with symmetric steps compensated using a bilateral hip strategy. These results suggest that step length asymmetry may provide information regarding underlying coordination mechanisms that can be used to guide rehabilitation efforts.

Another way to assess walking performance is to directly analyze deficits in muscle coordination. Recent studies have suggested that complex muscle activity during walking may be generated using a reduced neural control strategy organized around the co-excitation of multiple muscles, or modules, which may provide a useful framework for characterizing coordination deficits. Simulation analyses using modular control were performed to understand how modules contribute to important biomechanical functions of non-impaired walking and how the generation of these functions is altered in groups of post-stroke hemiparetic subjects who commonly merged different sets of non-impaired modules. The non-impaired simulation found that six modules are needed to generate the three-dimensional tasks of walking (support, forward propulsion, mediolateral balance control and leg swing control). When the plantarflexor module was merged with the module controlling the knee extensors and hip abductors, forward propulsion and ipsilateral leg swing were impaired. When the module controlling the hamstrings was merged with the module controlling the knee extensors and hip abductors, forward propulsion, body support and mediolateral balance control were impaired. These results suggest that module analysis may provide useful information regarding the source of walking deficits and can be used to guide rehabilitation efforts.