Interestingly, injury to the posterolateral putamen, a structure of the basal ganglia, was 60–80% more common in individuals with stroke who have TGA than those who walk symmetrically ( 12).
TGA can be characterized as having impaired locomotor rhythm, opposed to healthy gait, which features regular, reciprocal movements with an inherent rhythm. Thus, it is important to investigate other potential contributing factors. Some individuals with good motor recovery and an ability to walk quickly still walk asymmetrically ( 1), therefore the unilateral expression of motor deficits following stroke is not necessarily the sole cause of an asymmetric walking pattern. TGA is associated with motor impairment ( 1), but degree of motor recovery does not fully explain TGA. However, the stroke-related factors contributing to TGA are not yet fully understood. Therefore, development of new interventions that target TGA are needed and will depend on a clear understanding of the underlying mechanisms ( 11). Moreover, there is evidence that TGA may worsen over time ( 9, 10). Improving symmetry of gait is important because persistent TGA is associated with balance control deficiencies ( 5), bone density loss ( 6), joint pain and degeneration ( 7), and inefficient locomotion ( 8). This resistance to improvement is more likely a lack of training specificity for symmetry than an incapability of change ( 4). Exhibited by more than half of individuals with stroke ( 1, 2), TGA appears resistant to improvement during inpatient rehabilitation ( 3). Temporal gait asymmetry (TGA a phase inequality between the legs during gait) is a persistent issue following stroke.
While responsiveness of TGA to RAS did not significantly differ based on strength of rhythm abilities, these preliminary findings highlight rhythm ability as a potential consideration when treating post-stroke individuals with rhythm-based treatments. However, no interaction between TGA improvement when walking to metronome and rhythm perception or production ability was found. Moreover, individuals who worsened in TGA when walking to metronome had poorer beat production scores than those who did not change in TGA. Those with weak ability did not and exhibited high variability in the TGA response to metronome. Strong beat perceivers and producers showed significant reduction (improvement) in TGA with the metronome. Within-group analyses revealed a difference between strong and weak rhythm ability groups. Most individuals with stroke were able to maintain or improve TGA with a single session of RAS. We assessed change in TGA between walking without cues (baseline) and walking while synchronizing footsteps with metronome cues.
Assessed using behavioral tests of beat perception and production, participants with post-stroke TGA (measured as single limb support time ratio) were categorized according to rhythm ability (as strong or weak beat perceivers/producers). The purpose of this study was to investigate the relationship between rhythm abilities and responsiveness of TGA when walking to RAS. Responsiveness of TGA to RAS may be related to several factors including motor impairment, time post-stroke, and individual rhythm abilities. Compared to conventional gait training techniques, rhythmic auditory stimulation (RAS i.e., walking to a metronome) has demonstrated positive effects on post-stroke TGA. Temporal gait asymmetry (TGA) is a persistent post-stroke gait deficit.
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