Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

You can't do anything here until you get objective analysis of your gait deficits. Maybe one of these? 

Development and clinical validation of inertial sensor-based gait-clustering methods in Parkinson’s disease June 2019 

Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study  December 2017 

Markerless Human Motion Capture for Gait Analysis

written in October 2017, referring to research in October 2005. 

You wouldn't need further studies if you had started with objective measurements, then you could have directly created stroke protocols.

Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

éléna Lauzière 1,2, 
Martina Betschart 1,2, 
Rachid Aissaoui 3 and 
Sylvie Nadeau1,2*
1 Pathokinesiology Laboratory, Centre de recherche interdisciplinaire en réadaptation (CRIR) - Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), Quebec,Canada
2 Ecole de réadaptation, Université de Montréal, Quebec, Canada
3 Centre de Rec herc he du Centre Hospitalier Universitaire de Montréal (CRCHUM), Quebec, Canada
*
Corresponding author:
 Sylvie Nadeau, Professeure titulaire, Ecole de Réadaptation, Faculté de médecine, Université de Montréal, C.P.6128 Succ. Centre-ville,Montréal QC, Canada, Tel: (514) 343-2253 ; Fax: (514) 343-2105; E-mail :
sylvie.nadeau@umontreal.ca
Received date:
 01 April 2014;
Accepted date:
 20 May 2014;
Published date:
 23 May 2014
Copyright:
 © 2014 Lauziere S et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Gait asymmetry in spatial and temporal parameters and its impacts on functional activities have always raised many interesting questions in research and rehabilitation. The aim of this topical review is threefold: 1) to examine different equations of asymmetry of gait parameters and make recommendations for standardization, 2) to deepen the understanding of the relationships between sensorimotor deficits, spatio temporal (step length, swing time and double support time) and biomechanical (kinematic, kinetic, muscular activity) parameter asymmetries during gait and, 3) to summarize the impacts of gait asymmetry on walking speed, falls, and energy cost in individuals post stroke. In light of current literature, we recommend quantifying spatio temporal asymmetries by calculating symmetry ratios. However, for other gait parameters (such as kinetic or kinematic data), the choice will depend on the variability of the data and the objective of the study. Regardless of the selected asymmetry equation, we recommend presenting the asymmetry values in combination with the mean value of each side to facilitate comparisons between studies. This review also revealed that sensorimotor deficits clinically measured are not sufficient to explain the large variability of spatio temporal asymmetries (particularly for step length and double support time) in individuals poststroke. Biomechanical analysis has been identified as a relevant approach to understanding gait deviations. Studies that linked biomechanical impairments to spatio temporal asymmetries suggest that a balance issue and an impaired paretic forward propulsion could be among the important factors underlying spatio temporal asymmetries. In our opinion,(this should be your factual analysis, NOT opinion.) this paper provides meaningful information to aid in better understanding gait deviations in persons after stroke and establishes the need for future studies regrouping individuals post stroke according to their spatio temporal asymmetries. Furthermore, further studies targeting efficacy of locomotor rehabilitation and the impacts of gait asymmetry on risk of falls and energy expenditure are needed.