Effects of spatial and temporal pre-verbal prioritized instructions on spatiotemporal gait parameters in stroke patients: A within-subject repeated-measures study

Background Gait asymmetry is common after stroke. However, the differential effects of spatial versus temporal verbal instructions on spatiotemporal gait parameters remain poorly understood. Verbal instructions may also be understood as a modulation of attentional focus that engages distinct neural control strategies.Objective To investigate the effects of spatial and temporal pre-verbal prioritized instructions on spatiotemporal gait parameters compared with a no-prioritization condition in stroke patients.Methods Twenty-seven stroke patients walked under three randomized conditions: no prioritization, spatial prioritization (matching step length equally), and temporal prioritization (rhythmic counting aloud to match step timing equally). Spatiotemporal gait parameters were measured using the GAITRite® system. Repeated-measures ANOVA was used for primary analysis, with velocity-adjusted ANCOVA used to examine whether symmetry changes were independent of gait velocity.Results Significant main effects were found for velocity (F(2,52) = 13.917, p < .001), step time difference (F(2,52) = 5.463, p = .007), step time of less affected side (F(2,52) = 9.108, p < .001), step length of affected side (F(2,52) = 14.531, p < .001), and step length of less affected side (F(2,52) = 9.892, p < .001). Temporal prioritization produced significantly greater reduction in step time difference compared with both spatial prioritization and no prioritization, while producing less velocity reduction than spatial prioritization. Velocity-adjusted ANCOVA indicated that the step time difference effect remained significant after controlling for gait velocity (F(1,51) = 5.785, p = .020).Conclusions Temporal prioritization instruction acutely produced greater temporal gait symmetry improvement with less velocity reduction compared with spatial prioritization. Clinicians may consider temporal verbal cues as a potential strategy to address temporal gait asymmetry, though longitudinal studies are needed to determine retention and motor learning effects.