Does kinematic gait quality improve with functional gait recovery? A longitudinal pilot study on early post-stroke individuals

Typical clinical gait outcomes mostly focus on function; only sparse information exists on gait quality, i.e. symmetry or more natural gait patterns. It remains unclear whether functional gait recovery improves with gait quality, or whether these are two independent processes. The objective of this observational pilot study is to examine whether the gait quality improves with gait function (i.e. speed) over the course of early recovery. Full lower body gait kinematics were measured longitudinally in a clinical environment using wearable inertial measurement units. We recorded six individuals with subacute stroke (<1 month) for a total of 56 physical therapy sessions over the initial recovery stage of 12 weeks. We examined relations between gait symmetry in spatiotemporal, limb and joint kinematic parameters compared to gait function. We observed that overall gait symmetry improved with walking speed, but limb and joint kinematic parameters remained asymmetric at the maximum level of recovery (both p < 0.01). We also found that limb kinematic parameters (R-2 = 41.9%) of the impaired side was preferentially associated with functional gait recovery over joint kinematics (R-2 = 33.1%). These data suggest that our pilot cohort did not achieve "true" gait recovery despite achieving typical measures of recovery in gait speed and spatiotemporal symmetry. These initial results illustrate the multifaceted nature of recovery and justify further research on monitoring gait quality with a larger clinical study, providing insight for more effective training regimens. (C) 2020 Elsevier Ltd. All rights reserved.