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Thirty-nine adult individuals with stroke in the stable phase were asked to walk at their preferred speed and then as fast as possible. A set of gait indexes were computed, including spatial temporal parameters, ankle and hip mechanical work, and timing of ankle push-off onset, for comparison with normal velocity-dependent profiles. Algorithms were used to classify the resulting gait patterns when the patients walked at their preferred speed and fast and to identify the patients' strategies to maximise speed. Patients' strategies were characterised by a variation in the parameters, which were reduced, equal or increased, in relation to normal patterns. At both speeds, stroke individuals tended to walk at higher cadence and with shorter stride length. At the preferred speed the investigated parameters for all patients were mostly within the normal profile (71.8-94.9%). The exception was the finding of positive work at the ankle where 64% of the stroke individuals showed reduced work production. At fast speed (increments to 36%BH/s) fewer patients presented values within the normal profile for all the parameters (17.9-74.4%), with the exception of negative work at the ankle and hip. The parameter variations showed a more consistently abnormal picture. The results indicate that, in order to increase gait speed, patients with hemiparesis have different functional resources on which to draw, and these vary from individual to individual. Thus, gait analysis at different gait speed should be adopted to develop individualised programs that will improve quality of life for the patients.

The assessment of gait functionality in chronic stroke patients is fundamental in the design of the rehabilitation programme: the resources available must be evidenced in order to exploit them in the functional recovery. A potential increase of speed [1,2] appears to be a main feature to be identified, but it is relevant also to understand how speed increase is obtained: an increase of mechanical work is expected, but also timing of joints’ dynamics and emg patterns are potential contributors to speed gain. When considering the hemiplegic side in the rehabilitation context, an increase of mechanical work requires strengthening, while a modulation of timings requires a time-oriented activity: in this latter case, a biofeedback technique may be particularly fitting. In the present work a group of chronic stroke patients were required to walk at preferred and peak velocity, the gait analysis results evidenced the underlying factors and provided evidences for a rehabilitation program.

[1] Lamontagne A, et al. Faster is better: implication for speed intensive gait training after stroke. Stroke 2004;35:2543. [2] Jonsdottir J, Cattaneo C, Regola A, Crippa A, Recalcati M, Rabuffetti M, et al. Concepts of motor learning applied to a rehabilitation protocol using biofeedback to improve gait in a chronic stroke patient: an A-B system study with multiple gait analyses. Neural Rehabil Neural Repair 2006, in press.

s / Gait & Posture 30S (2009) S1–S25 S23 Positional biofeedback to improve gait in subjects with stroke A. Crippa 1 ,2a , J. Jonsdottir , R. Parelli 1 , M. Rabuffetti 3 ,A.Casiraghi 2 , D. Cattaneo 1,a1 LaRiCE, Italy 2 S.A.F.LO, Italy 3 Polo tecnologico, Italy Introduction The purpose of our study was to investigate the effectiveness ofpositional bio-feedback on reducing gait impairments in a popula-tion with hemiparesis following stroke. Positional BFB was used toimprovepatient’sabilitytoself-regulatethemovementtoaspecificjointangleorbodysegmentpositioninordertoimprovesymmetryof gait.Biofeedback is a technique in which a person is given informa-tion about physiological processes that is not normally available tothemwiththegoalofgainingconsciouscontrolofthoseresponses.Inordertomaximizetheeffectoffeedbackinlearningmotoractiv-ities,weprovideda“dynamicbiofeedback”inwhichfeedbackfromakinematicvariableisprovidedduringfunction-relatedtasktrain-ing in accordance with current theories of motor learning [1,2].In neuromotor rehabilitation, task-oriented training encourages apatienttoexploretheenvironmentandtosolvespecificmovementproblems.The purpose of this presentation is to provide preliminary evi-dences concerning a subset of variables used to characterize thegait cycle.

s of the SIAMOC 2008 Congress / Gait & Posture 29S (2009) e1–e31 e30 Discussion: Arm and leg coordination is significantly different between overground and treadmill walking. In particular, during TW, the arm and leg swing movements are ‘‘more out of phase’’ with respect to OW. This is connected to a significant increase of cadence in TWand, consequently, to an increase in the swing phase duration, which anticipated the instant of maximum thigh extension. The increase in cadence could be due to the fact that propioceptive, vestibular and visual inputs are different in comparison to OW. In particular the absence of optical flow generates in subjects the visual perception of ‘‘walking slower than they actually do’’, leading to the attempt of augmenting the velocity. The results of this attempt could be the increase in cadence. The 50% of the arms which showed a 2:1 frequency ratio in OW, were those which had a stride frequency below the natural pendular frequency (NPF) of the arms. The seven arms which switched from a 2:1 to a 1:1 ratio passing from OW to TW were only those whose cadence in TW exceeded the NPF. It is suggested that the increase in cadence shown in TW, together with the mechanical properties of the upper limbs affect the neural mechanism which controls the way we coordinate upper and lower limbs movements during gait.