Symmetry Is Associated With Interlimb Coordination During Walking and Pedaling After Stroke

Authors

Brice T. Cleland, Marquette University
Sheila M. Schindler-Ivens, Marquette UniversityFollow

Document Type

Article

Publication Date

4-2022

Publisher

Lippincott Williams & Wilkins

Source Publication

Journal of Neurologic Physical Therapy

Source ISSN

1557-0576

Abstract

Background and Purpose:

Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.

Methods:

Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsion_walk, %Work_ped) and interlimb phase coordination index (PCI_walk, PCI_ped) were computed. Clinical evaluations were the lower extremity Fugl-Meyer (FMLE) and walking speed. Associations were assessed with Spearman's rank correlations.

Results:

Participants with stroke displayed asymmetry and impaired interlimb coordination compared with controls (P ≤ 0.001). There were significant correlations between asymmetry and impaired interlimb coordination (walking: R² = 0.79, P < 0.001; pedaling: R² = 0.62, P < 0.001) and between analogous measures across tasks (%Work_ped, %Propulsion_walk: R² = 0.41, P = 0.01; PCI_ped, PCI_walk: R² = 0.52, P = 0.003). Regardless of task, asymmetry and interlimb coordination were correlated with FMLE (R² ≥ 0.48, P ≤ 0.004) but not walking speed. There was larger within group variation for %Propulsion_walk than %Work_ped (Z = 2.6, P = 0.005) and for PCI_ped than PCI_walk (Z = 3.6, P = 0.003).

Discussion and Conclusions:

Pedaling may provide useful insights about walking, and impaired interlimb coordination may contribute to asymmetry in walking. Pedaling and walking provide distinct insights into stroke-related impairments, related to whether the task allows compensation (walking > pedaling) or compels paretic limb use (pedaling > walking). Pedaling a device with a bisected crank shaft may have therapeutic value.

Comments

Accepted version. Journal of Neurologic Physical Therapy, Vol. 46, No. 2 (April 2022): 81-87. DOI. © 2022 Lippincott Williams & Wilkins, Inc. Used with permission.

Recommended Citation

Cleland, Brice T. and Schindler-Ivens, Sheila M., "Symmetry Is Associated With Interlimb Coordination During Walking and Pedaling After Stroke" (2022). Physical Therapy Faculty Research and Publications. 189.
https://epublications.marquette.edu/phys_therapy_fac/189