Speed-dependent biomechanical changes vary across individual gait metrics post-stroke relative to neurotypical adults

BackgroundGait training at fast speeds is recommended to reduce walking activity limitations post-stroke. Fast walking may also reduce gait kinematic impairments post-stroke. However, the magnitude of speed-dependent kinematic impairment reduction in people post-stroke relative to neurotypical adult walking patterns is unknown. ObjectiveTo determine the effect of faster walking speeds on gait kinematics post-stroke relative to neurotypical adults walking at similar speeds. MethodsWe performed a secondary analysis with data from 28 people post-stroke and 50 neurotypical adults treadmill walking at multiple speeds. We evaluated the effects of speed and group on individual spatiotemporal and kinematic metrics and performed k-means clustering with all metrics at self-selected and fast speeds ResultsPeople post-stroke decreased step length asymmetry and trailing limb angle impairment, reducing between-group differences at fast speeds. Speed-dependent changes in peak swing knee flexion, hip hiking, and temporal asymmetries exaggerated between-group differences. Our clustering analyses revealed two clusters. One represented neurotypical gait behavior, composed of neurotypical and post-stroke participants. The other characterized stroke gait behavior, comprised entirely of participants post-stroke. Cluster composition was largely consistent at both speeds, and the distance between clusters increased at fast speeds ConclusionsThe biomechanical effect of fast walking post-stroke varied across individual gait metrics. For participants within the stroke gait behavior cluster, speed-dependent changes did not lead to an overall gait pattern more similar to neurotypical adults. This suggests that combining fast walking with an approach to strategically target gait metrics with smaller speed-dependent changes may potentiate the biomechanical benefits of fast walking.