Speed-dependent changes in the arm swing during independent walking in individuals after stroke

BACKGROUND: Increasing one's walking speed is an important goal in post-stroke gait rehabilitation. Insufficient arm swing in people post-stroke might limit their ability to propel the body forward and increase walking speed. PURPOSE: To investigate the speed-dependent changes (and their contributing factors) in the arm swing of persons post-stroke. MATERIAL AND METHODS: Twenty-five persons post-stroke (53±12.1 years; 40.72±43.0 months post-stroke) walked on a treadmill at comfortable (0.83m/s) and fast (1.01m/s) speed. Shoulder and elbow kinematics were compared between conditions using Statistical Parametric Mapping (SPM) analysis, and discrete parameters using a Wilcoxon signed-rank test or an independent sample t-test. The relations between speed-dependent changes in shoulder and elbow range of motion and clinical and gait parameters were assessed using Spearman correlation coefficients. RESULTS: The non-paretic arm showed expected speed-dependent kinematic adaptations with increases in active range of motion for shoulder flexion (p<0.001), extension (p<0.05), abduction (p = 0.001), rotation (p = 0.004) and elbow flexion (p<0.001). The paretic arm only showed an increase in shoulder abduction and elbow flexion (both p<0.001). Persons post-stroke with a more impaired arm swing coordination pattern only showed speed-dependent adaptations for elbow flexion (p<0.001) at the paretic side during fast walking. In contrast, persons post-stroke with a normal arm swing coordination pattern presented with increases in active range of motion of the shoulder abduction and elbow flexion (both p<0.001) at the paretic side when walking fast. More upper limb impairment (r = -0.521, p<0.01) and a wider step width (r = 0.534, p<0.01) were related to a larger increase in mean elbow flexion during faster walking. CONCLUSIONS: Persons post-stroke show different changes in arm swing kinematics at the paretic compared to the non-paretic side when increasing walking speed. The changes are related to the impairment level and stability during walking, indicating that therapeutic interventions aiming to increase walking speed by improving arm swing might need to target these factors.