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Individual differences in locomotor function predict the capacity to reduce asymmetry and modify the energetic cost of walking post-stroke

Changes in the control of the lower extremities post-stroke lead to persistent biomechanical asymmetries during walking. These asymmetries are associated with an increase in energetic cost, leading to the possibility that reduction of asymmetry can improve economy. However, the influence of asymmetry on economy may depend on the direction and cause of asymmetry. For example, impairments with paretic limb advancement may result in shorter paretic steps while deficits in paretic support or propulsion result in shorter non-paretic steps. Given differences in the underlying impairments responsible for each type of step length asymmetry, the capacity to reduce asymmetry, and the associated changes in energetic cost may not be consistent across this population. Here, we identified factors explaining individual differences in the capacity to voluntarily reduce step length asymmetry and modify energetic cost during walking. Twenty-four individuals post-stroke walked on a treadmill with visual feedback of their step lengths to aid explicit modification of asymmetry. We found that individuals who naturally took longer paretic steps had a greater capacity to reduce asymmetry, and were better able to transfer the effects of training to over-ground walking. In addition, baseline energetic cost was negatively correlated with reductions in cost, such that participants with a more economical gait were more likely to reduce energetic cost by improving symmetry. These results demonstrate that many stroke survivors retain the capacity to voluntarily walk more symmetrically on a treadmill and over-ground. However, whether reductions in asymmetry reduce metabolic cost depends on individual differences in impairments affecting locomotor function.