Gait after stroke - are velocity and symmetry relevant aims for rehabilitation?

Introduction: Most stroke survivors experience gait difficulties to some extent. Regaining independent gait is an important aim in stroke rehabilitation and is closely related to activity and participation in several community areas. This paper presents an overview of studies concerning stroke survivors with gait velocity and symmetry as the main focus. Main part: Chronic stroke survivors walk more slowly than healthy individuals and their energy expenditure is 1, 5-2 times as high when walking at the same velocity. Slow gait can by being less automatic, contribute to higher energy demands, while faster gait is more energy efficient due to more coordinated movement patterns. Gait velocity can be increased through gait related endurance training and high intensive functional strength training. However, the evidence supporting that strength- and gait-related endurance training might lead to more symmetric gait patterns, is insufficient. Summary: Although gait velocity is a reliable measure of improvement of gait, it does not adequately reflect independence in complex outdoor environments. Keeping a comfortable gait speed with less muscular effort, is perhaps more important than fast walking, as this might lead to a more functional and flexible gait where the individual is able to change velocity as needed