Curved walking in hemiparetic patients

Objective: Curved walking requires complex adaptations, including shift of body weight to counteract the ensuing centrifugal force, and the production of strides of different length between legs. We hypothesized that gait capacities would be more stressed in hemiparetic patients than in healthy subjects when walking along curved, compared with straight, trajectories. Methods: Twenty chronic, stabilized stroke patients and 20 healthy subjects walked along straight or curved trajectories. Mean cadence and gait velocity were off-line computed from video recordings. An electronic walkway detected asymmetry of single support and degree of foot yaw angle at mid-stance. Centre of pressure during standing was recorded by posturography. Results: Compared with linear walking, the velocity of curved walking was not significantly smaller in patients, and was independent of affected body side or direction of rotation. It was inversely correlated with paretic limb weakness, asymmetry of single support, and shift of centre of pressure toward the healthy side. External rotation of the paretic foot relatively favoured curved walking toward the paretic side. Conclusion: Curved locomotion is defective in stabilized stroke patients, but impairment is not dependent on direction of rotation, indicating a shared task between legs or occurrence of effective functional adaptation. These findings advocate rehabilitation exercises targeting complex gait adaptations, including curved walking.