Center-of-Mass Work Patterns Reveal a Dissociation Between Gait Organization and Limb-level Mechanical Function in Post-stroke Walking

Abstract

Walking speed is widely used to assess gait recovery following stroke, yet it provides limited insight into how walking performance is mechanically organized. This study examined how center-of-mass (COM) work organization and propulsion–support coupling vary across walking speeds in individuals with post-stroke hemiparesis to distinguish recovery of gait organization from recovery of limb-level mechanical function. Eleven individuals with post-stroke hemiparesis performed treadmill walking across speeds ranging from 0.2 to 0.7 m/s while ground-reaction forces were recorded. Limb-specific COM power and work were computed using an individual-limbs framework, and interlimb asymmetry in net and positive work, along with the propulsion–support ratio (PSR), were quantified. A qualitative transition in gait organization was observed: at lower walking speeds, COM power exhibited a simplified two-phase pattern, whereas at higher walking speeds (approximately ≥0.5 m/s), a structured four-phase COM power pattern emerged, including identifiable push-off and preload phases. Despite this recovery of gait organization, interlimb work asymmetry remained elevated and paretic PSR remained reduced across all speeds, indicating persistent limb-level mechanical deficits. These findings demonstrate that increases in walking speed and the emergence of typical COM power structure reflect recovery of gait organization rather than restoration of underlying limb-level mechanical capacity. Consequently, walking speed alone is insufficient to characterize gait recovery after stroke, and biomechanically informed measures of COM work organization and propulsion–support coupling provide complementary insight by distinguishing organizational recovery from limb-level mechanical recovery.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

N/A

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB21-120 1576).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability Declaration

The datasets used in this study are available in the author’s public repository on GitHub at: salehhosseini/Hemiparetic-dataset: Hemi Paretic Walking Dataset

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