Quantifiable patterns of limb loading and unloading during hemiparetic gait: Relation to kinetic and kinematic parameters

Persons with poststroke hemiparesis are characterized by asymmetry in limb loading (LL) and limb unloading (LU), which has been reported in static and quasi-static tasks but has not been quantified during walking. The purpose of this study was to determine the asymmetry in magnitude and duration of LL and LU in individuals with hemiparesis and its relationship with functional walking status and specific kinematic and kinetic variables during walking. Forty-four participants with chronic hemiparesis walked at their self-selected speeds and eighteen nondisabled control subjects of similar ages walked at predetermined matched speeds while three-dimensional ground reaction forces and body-segment kinematics were recorded. Magnitude of paretic LL was reduced, while duration was increased compared with the nonparetic leg and nondisabled controls walking at matched speeds. The paretic LL and LU was significantly correlated with average leg angle, while the nonparetic leg significantly correlated with average knee angle. Three different patterns of LL and LU were identified (concave, convex, and linear). Individuals with hemiparesis make several biomechanical adjustments that minimize LL of the paretic leg. LL deviations were more pronounced with increased lateral placement of the paretic foot and with decreased functional gait speed. Characterization of these deviations may inspire new strategies for rehabilitation.