Association of trunk sway and gait-cycle variability measured by triaxial accelerometry with heart rate-based walking efficiency in patients with mild hemiparesis

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Association of trunk sway and gait-cycle variability measured by triaxial accelerometry with heart rate-based walking efficiency in patients with mild hemiparesis

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https://doi.org/10.1016/j.clinbiomech.2026.106809Get rights and content

Highlights

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  Triaxial accelerometry showed hemiparesis patients' trunk sway & gait variability.
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  Root mean square and coefficient of variation correlated with walking efficiency.
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  Trunk sway and gait-cycle variability correlated with walking efficiency.
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  Accelerometry-derived parameters may guide targeted rehabilitation strategies.

Abstract

Background

The walking efficiency of individuals who have experienced a stroke and have mild hemiparesis may be reduced even in the absence of visually apparent gait abnormalities. We investigated the association between several gait parameters assessed by a triaxial accelerometer and walking efficiency in this population.

Methods

Patients with first-ever stroke and mild hemiparesis who could ambulate independently without assistive devices (n = 36) were included. Gait assessments were conducted when the patients were able to walk continuously for ≥14 m and for 3 min. We used the root mean square (RMS) of acceleration to quantify the patients' trunk sway during walking. Trunk asymmetry and gait-cycle variability were assessed with the Lissajous index and coefficient of variation (CV), respectively. Walking efficiency was evaluated with the Physiological Cost Index (PCI). Correlation and multiple regression analyses were performed, with age and lower-limb motor function assessed by the Stroke Impairment Assessment Set (SIAS) as covariates.

Findings

The RMS results (composite: ρ = 0.65, mediolateral: ρ = 0.64, vertical: ρ = 0.65, anteroposterior: ρ = 0.51) and CV (ρ = 0.49) were significantly positively correlated with the PCI results (p < 0.01). The SIAS lower-limb score was significantly negatively correlated with the PCI (ρ = −0.47, p < 0.01). No significant associations were observed for the Lissajous index or age. The multiple regression analysis identified all RMS components and CV as independent predictors of PCI results.

Interpretation

In patients with mild hemiparesis, trunk sway and gait-cycle variability were associated with decreased walking efficiency. The mediolateral and vertical RMS values and CV may serve as sensitive indicators of gait-related energy inefficiency.

Introduction

Approximately 80% of stroke survivors are expected to regain independent ambulation (Jørgensen et al., 1995; Preston et al., 2011), and restoring walking ability is frequently a key goal in rehabilitation to help stroke patients maintain their activities of daily living (ADLs) and quality of life (QOL) (Raab et al., 2020). In daily activities, the ability to walk efficiently — not just walk — is essential for effective motor performance. Investigations of stroke patients have demonstrated that greater walking efficiency not only improves these patients' ambulatory ability; it also reduces fatigue accumulation, enabling greater walking endurance and sustained ADL independence after discharge, thereby improving the patients' overall QOL (Compagnat et al., 2022; Ribeiro et al., 2019). These findings emphasize the clinical importance of achieving an energy-efficient gait.

Stroke survivors often develop abnormal gait patterns during recovery (Patterson et al., 2010; Wang et al., 2020), which may interfere with achieving energy-efficient walking. Conspicuous gait abnormalities such as genu recurvatum and knee buckling are frequently observed in patients with severe motor or sensory deficits (Okada et al., 2024). In contrast, stroke patients with relatively mild impairments may experience subtler disturbances such as trunk sway, asymmetry of trunk motion, and/or variability in gait-cycle timing, which are difficult to detect visually (Van Criekinge et al., 2017).

Triaxial accelerometers have been increasingly used in gait assessments due to their noninvasive and convenient properties. These devices allow for the quantification of trunk sway during gait by providing the root mean square (RMS) of acceleration, and they enable the measurement of gait-cycle variability by providing the coefficient of variation (CV). The RMS and CV can be used as quantitative indices of spatial and temporal gait features, offering more objective and detailed evaluations compared to visual inspection (Henriksen et al., 2004; Mizuike et al., 2009). We hypothesized that triaxial accelerometers may be particularly useful for assessing subtle gait disturbances in stroke survivors with mild hemiparesis.

Several research groups have demonstrated that both the RMS and CV are associated with the risk of falling and gait independence in older adults and stroke patients (Kijima et al., 2018; Mahoney et al., 2017; Sawa et al., 2014), which suggests that gait disturbances that are measurable by triaxial accelerometers (e.g., trunk sway, asymmetry, and gait-cycle variability) may contribute to decreased walking efficiency. However, to the best of our knowledge, the relationship between walking efficiency and such gait parameters has not been investigated in stroke patients with mild impairments — in whom gait abnormalities are less apparent.

We thus conducted the present study to investigate the relationships between gait parameters obtained with a triaxial accelerometer and the walking efficiency of stroke patients with mild hemiparesis. Understanding these relationships may offer new insights into rehabilitation strategies targeting walking efficiency in this patient population.

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