The Impact of Upper Limb Functioning on Gait Patterns in Individuals with Post-Stroke Hemiplegia
G. D. S. Pushpika *
Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
T. N. Samaranayake
Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka.
*Author to whom correspondence should be addressed.
Abstract
Hemiplegia resulting from a stroke leads to a distinct gait pattern and dysfunction in the upper limb. The objective of this study was to determine a correlation between the functionality of the upper limb and selected spatiotemporal parameters of gait in patients with hemiplegia following a stroke. The study comprised a sample of 80 outpatients (45 males and 35 females) with post-stroke hemiplegia, with an average age of 60.78 years, selected using a convenient sampling method. To assess the functionality of the affected upper limb, the study employed the QuickDASH questionnaire, which is a shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire. Concurrently, the participants were recorded on video while performing the 4-meter walk test (4mWT). The recorded videos were meticulously analyzed using Kinovea software (version 0.8.15) to calculate gait parameters such as comfortable and maximum speeds, stride length and time on the paretic and affected side, number of steps taken to cover the 4m, and cadence. Pearson Correlation analysis was conducted to explore potential associations between these gait parameters and the QuickDASH score, with a significance level of p < 0.05.
The findings revealed significant correlations between upper limb functionality and selected gait parameters. Reduced upper limb functionality correlated with decreased comfortable speed (p < 0.05), maximum speed (p < 0.05), and cadence (p < 0.05) during the 4mWT. In contrast, impaired upper limb function linked to prolonged time to complete the 4m distance (p < 0.05), increased steps taken by both affected (p < 0.05) and unaffected (p < 0.05) sides, and extended stride time on both sides (p < 0.05). However, no substantial correlation emerged between upper limb functionality and stride length on either side (p > 0.05).
In conclusion, this study emphasizes the correlation between upper limb functionality and specific gait parameters in post-stroke hemiplegic patients. The correlation between upper limb functionality and selected spatiotemporal parameters of gait underscores the necessity for integrated rehabilitation strategies targeting both upper limb and gait training. These findings contribute to a deeper comprehension of the connection between upper limb disability and gait parameters, emphasizing the significance of personalized treatments in order to maximize the restoration of functionality in individuals who have suffered a stroke.
Keywords: QuickDASH score, post-stroke hemiplegia, 4m walk test, stroke, gait parameter
How to Cite
Downloads
References
Alsop Helen BA. et al . Chapter 1. 15th edn, tidy’s physiotherapy. 15th edn. Edited by S. Porter. Elsevier; 2013
Wijeratne T. Neurorehabilitation in Sri Lanka: an emerging sub-specialty for neurology trainees. Int J Stroke. 2012; 7(2):163-4. DOI: 10.1111/j.1747-4949.2011.00625.x. Epub 2011 Oct 4. PMID: 21967513
Raj GS. Physiotherapy in Neuro-conditions. 1st edn. New Delhi: Jaypee Brothers Medical Publishers; 2006
Li S. Spasticity, Motor recovery, and neural plasticity after stroke. Front Neurol. 2017;8:120. DOI: 10.3389/fneur.2017.00120. PMID: 28421032; PMCID: PMC5377239
Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review. J Stroke. 2017;19(3):286-294. DOI: 10.5853/jos.2017.00234. Epub 2017 Sep 29. Erratum in: J Stroke. 2018 ;20(1):142. PMID: 29037005; PMCID: PMC5647629.
Gunaratne P. Stroke in Sri Lanka: Remedies for recovery, Journal of the Ceylon College of Physicians. 2009;42(1–2):3.
DOI: 10.4038/jccp.v42i1-2.4547
Wang Y, Mukaino M, Ohtsuka K, Otaka Y, Tanikawa H, Matsuda F, Tsuchiyama K, Yamada J, Saitoh E. Gait characteristics of post-stroke hemiparetic patients with different walking speeds. Int J Rehabil Res. 2020;43(1):69-75. DOI: 10.1097/MRR.0000000000000391 PMID: 31855899; PMCID: PMC7028468.
Roby-Brami A, Jarrassé N, Parry R. Impairment and compensation in dexterous upper-limb function after stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci. 2021; 15:662006.
DOI: 10.3389/fnhum.2021.662006 PMID: 34234659; PMCID: PMC8255798.
Luke, Carolyn; Dodd, Karen J; Brock, Kim. Outcomes of the Bobath concept on upper limb recovery following stroke. Clinical Rehabilitation, 2009;18(8), 888–898. DOI:10.1191/0269215504cr793oa
Buraschi, R.,Pollet J2, Alghisi B et al. ‘P 159 - Gait in stroke patients is influenced by upper limb functioning: A quantitative analysis correlating QuickDASH with Instrumented TUG and 10MWT’, Gait and Posture. Elsevier. 2018;65(supplement 1), 503–504. DOI: 10.1016/j.gaitpost.2018.07.080
Bovonsunthonchai S, Hiengkaew V, Vachalathiti R, Vongsirinavarat M, Tretriluxana J. Effect of speed on the upper and contralateral lower limb coordination during gait in individuals with stroke. Kaohsiung J Med Sci. 2012; 28(12):667-72.
DOI: 10.1016/j.kjms.2012.04.036 Epub 2012 Jul 28. PMID: 23217359.
Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G; EPOS Investigators. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study. Stroke. 2010;41(4):745-50. DOI: 10.1161/STROKEAHA.109.572065 Epub 2010 Feb 18. PMID: 20167916.
Stinear CM, Barber PA, Petoe M, Anwar S, Byblow WD. The PREP algorithm predicts potential for upper limb recovery after stroke. Brain. 2012;135(Pt 8):2527-35.
DOI: 10.1093/brain/aws146 Epub 2012 Jun 10. PMID: 22689909.
Veerbeek JM, Van Wegen EE, Harmeling-Van der Wel BC, Kwakkel G; EPOS Investigators. Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study. Neurorehabil Neural Repair. 2011; 25(3):268-74. DOI: 10.1177/1545968310384271 Epub 2010 Dec 26. PMID: 21186329.
Ballester BR, Maier M, Duff A, Cameirão M, Bermúdez S, Duarte E, Cuxart A, Rodríguez S, San Segundo Mozo RM, Verschure PFMJ. A critical time window for recovery extends beyond one-year post-stroke. J Neurophysiol. 2019;122(1):350-357. DOI: 10.1152/jn.00762.2018. Epub 2019 May 29. PMID: 31141442; PMCID: PMC6689791.
Ghose M, Das R, Barua AR, Deka P, Barman A, Borah NC, Chowdhury N, Barman A. A Five-Year retrospective cohort study of survivality and functional outcomes of stroke patients following hospital admission. Ann Neurosci. 2022; 29(2-3):144-150. DOI: 10.1177/09727531221109106 Epub 2022 Jul 19. PMID: 36419511; PMCID: PMC9676343.
Panpan Yu, Wei Zhang, Yansheng Liu, Caihong Sheng, Kwok-Fai So, Libing Zhou, Hui Zhu. Chapter Eight - The effects and potential mechanisms of locomotor training on improvements of functional recovery after spinal cord injury. International Review of Neurobiology. 2019;147: 199-217. DOI:10.1016/bs.irn.2019.08.003. Available:(https://www.sciencedirect.com/science/article/pii/S0074774219300686)
Ogawa T, Sato T, Ogata T, Yamamoto SI, Nakazawa K, Kawashima N. Rhythmic arm swing enhances patterned locomotor-like muscle activity in passively moved lower extremities. Physiol. Rep. 2015;3:e12317. DOI: 10.14814/phy2.12317. [PMC free article]
Stephenson JL., De Serres S.J., Lamontagne A. The effect of arm movements on the lower limb during gait after a stroke. Gait Posture. 2010;31:109–115.
DOI: 10.1016/j.gaitpost.2009.09.008
Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther. 2013;36(1):24-30. DOI: 10.1519/JPT.0b013e318248e20d. PMID: 22415358
Ng SS, Au KK, Chan EL, Chan DO, Keung GM, Lee JK, Kwong PW, Tam EW, Fong SS. Effect of acceleration and deceleration distance on the walking speed of people with chronic stroke. J Rehabil Med. 2016;48(8):666-670. DOI: 10.2340/16501977-2124. PMID: 27534654.