Background Persons with central neurological disorders frequently experience gait impairments which are often associated with joint hyper-resistance. To assess joint hyper-resistance, clinical assessments generally rely on passive joint rotations, yet their specific relationship with gait impairments remains unclear. This systematic review aimed to determine the relationship between clinical lower-extremity joint hyper-resistance scores and gait kinematics in patients with central neurological disorders. Methods A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and Web of Science were searched up to March 15, 2025. Eligibility criteria included studies involving patients with central neurological disorders, assessing lower-limb hyper-resistance using non-instrumented clinical tests, and analyzing gait kinematics via three-dimensional motion analysis. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Data on clinical scores, gait parameters, and reported correlations were extracted and synthesized. Results Fifty studies met the inclusion criteria. Passive range of motion, the modified Ashworth Scale, and the popliteal angle test were most frequently used, primarily targeting the m. triceps surae, hamstrings, and m. quadriceps femoris. Eight studies directly analyzed relationships between clinical scores and gait kinematics, reporting limited and inconsistent correlations. Discussion Only a few studies directly assessed the relationship between clinical lower-extremity joint hyper-resistance scores and gait kinematics. The studies showed that conventional clinical assessments of joint hyper-resistance have limited predictive value for functional gait deviations, though they remain useful for identifying severe impairments and guiding treatment decisions. Future research should investigate how clinical assessments can better guide clinical gait analysis, and whether more objective (e.g., instrumented, or functional) assessments can improve the relationship between clinical assessments and functional gait deviations.
Hozeman et al. (Mon,) studied this question.