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Gait Velocity and Joint Power Generation After Stroke

Contribution of Strength and Balance

Mentiplay, Benjamin F. PhD; Williams, Gavin PhD; Tan, Dawn ClinDoc(Physio); Adair, Brooke PhD; Pua, Yong-Hao PhD; Bok, Chek Wai MD; Bower, Kelly J. PhD; Cole, Michael H. PhD; Ng, Yee Sien MD; Lim, Lek Syn DipEng; Clark, Ross A. PhD

American Journal of Physical Medicine & Rehabilitation: October 2019 - Volume 98 - Issue 10 - p 841–849
doi: 10.1097/PHM.0000000000001122
CME Article . 2019 Series . Number 10

Objective The aim of the study was to assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke.

Design Sixty-three participants in a multisite, multinational, cross-sectional, observational study underwent assessment of gait velocity (10-m walk test), standing balance (computerized posturography), and isometric strength (hand-held dynamometry). Twenty-seven participants had joint power generation assessed (three-dimensional gait analysis). Bivariate associations were examined using Spearman’s correlations. Regression models with partial F tests were used to compare the contribution to gait between measures.

Results Although all muscle groups demonstrated significant associations with gait velocity (ρ = 0.40–0.72), partial F tests identified that ankle plantar flexor and hip flexor strength made the largest contribution to gait velocity. Ankle plantar flexor strength also had strong associations with habitual and fast-paced ankle power generation (ρ = 0.65 and 0.75). Balance had significant associations with habitual and fast gait velocity (ρ = −0.57 and −0.53), with partial F tests showing that the contribution was independent of strength.

Conclusions Ankle plantar flexor and hip flexor strength had the largest contribution to gait velocity. Future research may wish to refocus strength assessment and treatment to target the ankle plantar flexors and hip flexors.

To Claim CME Credits Complete the self-assessment activity and evaluation online at

CME Objectives Upon completion of this article, the reader should be able to: (1) Differentiate the contribution that lower limb strength of each muscle group has on gait velocity after stroke; (2) Appraise the relationship between isometric strength and joint power generation during gait; and (3) Interpret the contribution of both strength and balance to gait after stroke.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia (BFM); Victorian Infant Brain Studies, Murdoch Children’s Research Institute, Melbourne, Australia (BFM); Physiotherapy Department, Epworth HealthCare, Melbourne, Australia (BFM, GW); Physiotherapy Department, University of Melbourne, Melbourne, Australia (GW, KJB); Physiotherapy Department, Singapore General Hospital, Singapore (DT, Y-HP); Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia (BA); Department of Rehabilitation Medicine, Singapore General Hospital, Singapore (CWB, YSN); Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia (MHC); Movement Science Laboratory, Singapore General Hospital, Singapore (LSL); and Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia (RAC).

All correspondence should be addressed to: Benjamin F. Mentiplay, PhD, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia.

BFM was funded by an Endeavour Research Fellowship from the Australian Government, Department of Education and Training; GW was funded by a National Health and Medical Research Council Translating Research into Practice Fellowship; and RAC was funded by a National Health and Medical Research Council Career Development Fellowship. The funding bodies had no involvement in the study.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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Online date: December 29, 2018

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