Document Type : Original Article


Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospital, Bangalore, India


Background: Poor motor recovery of hip muscles affect the walking post-stroke. The study objective was to examine how lower extremity motor function and hip muscle weakness are related to weight-bearing asymmetry (WBA), excessive pelvic tilt, and gait speed in stroke survivors.
Methods: Eighty patients with chronic stroke, a mean and standard deviation (SD) of post-stroke duration of 350 ± 664 days, age of 30-70 years, independent standing, and 10-meter walking capacity participated in the study. Hip muscular strength was measured using a handheld dynamometer (HHD) and motor function was assessed by Fugl-Meyer Assessment of lower extremity (FMA-LE). The WBA was recorded using two weighing scales; whereas the pelvic tilt and gait speed were evaluated using palpation meter (PALM) and 10-meter walk test, respectively.
Results: The muscles strength of hip flexors, extensors, abductors, and adductors of the paretic side ranged between 22.0 and 24.4 pounds. The mean score of FMA-LE was 22 points. Following Pearson product-moment correlation with statistically significant P < 0.05, the relationship of hip muscles strength and FMA with WBA, lateral pelvic tilt (LPT) and anterior pelvic tilt (APT), and speed are as follows: flexors (r = 0.47, r = 0.31, r = 0.44, r = 0.44), extensors (r = 0.45, r = 0.38, r = 0.37, r = 0.35), abductors (r = 0.49, r = 0.32, r = 0.38, r= 0.40), adductors (r = 0.45, r = 0.31, r = 0.23, r = 0.34), and motor function (r = 0.62, r = 0.33, r = 0.38, r = 0.62).
Conclusion: Motor performance of the paretic lower limb was highly correlated with WBA and gait speed in stroke survivors. Overall hip muscle strength of paretic side had a moderate correlation with WBA, excessive pelvic tilt, and gait speed.


  1. Adamson J, Beswick A, Ebrahim S. Is stroke the most common cause of disability? J Stroke Cerebrovasc Dis 2004; 13(4): 171-7.
  2. Arene N, Hidler J. Understanding motor impairment in the paretic lower limb after a stroke: A review of the literature. Top Stroke Rehabil 2009; 16(5): 346-56.
  3. Dorsch S, Ada L, Canning CG. Lower Limb strength is significantly impaired in all muscle groups in ambulatory people with chronic stroke: A cross-sectional study. Arch Phys Med Rehabil 2016; 97(4): 522-7.
  4. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil 2002; 83(8): 1138-44.
  5. Kirker SG, Jenner JR, Simpson DS, Wing AM. Changing patterns of postural hip muscle activity during recovery from stroke. Clin Rehabil 2000; 14(6): 618-26.
  6. Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil 2008; 89(2): 304-10.
  7. Pathak S, Vijaya K, Nayak A, Kedambadi RC. The relationship between pelvic alignment and trunk control in stroke subjects: A cross-sectional study. Int J Res Med Sci 2014; 2(4): 1483-7.
  8. Karthikbabu S, Chakrapani M, Ganesan S, Ellajosyula R. Relationship between pelvic alignment and weight-bearing asymmetry in community-dwelling chronic stroke survivors. J Neurosci Rural Pract 2016; 7(Suppl 1): S37-S40.
  9. Neptune RR, Zajac FE, Kautz SA. Muscle force redistributes segmental power for body progression during walking. Gait Posture 2004; 19(2): 194-205.
  10. Higginson JS, Zajac FE, Neptune RR, Kautz SA, Delp SL. Muscle contributions to support during gait in an individual with post-stroke hemiparesis. J Biomech 2006; 39(10): 1769-77.
  11. Tyson SF. Trunk kinematics in hemiplegic gait and the effect of walking aids. Clin Rehabil 1999; 13(4): 295-300.
  12. Cruz TH, Lewek MD, Dhaher YY. Biomechanical impairments and gait adaptations post-stroke: Multi-factorial associations. J Biomech 2009; 42(11): 1673-7.
  13. Mentiplay BF, Adair B, Bower KJ, Williams G, Tole G, Clark RA. Associations between lower limb strength and gait velocity following stroke: A systematic review. Brain Inj 2015; 29(4): 409-22.
  14. Itotani K, Murakami M, Itotani M, Nagai A, Imabori Y, Fujimoto K, et al. Relationship between the weight-bearing ratio on the affected lower extremity and gait ability using a portable electronic foot sensor shoe (Step Aid((R))) in hemiplegic stroke patients. J Phys Ther Sci 2015; 27(2): 321-3.
  15. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther 1983; 63(10): 1606-10.
  16. Karthikbabu S, Chakrapani M. Hand-held dynamometer is a reliable tool to measure trunk muscle strength in chronic stroke. J Clin Diagn Res 2017; 11(9):
  17. Bohannon RW. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther 1986; 66(2): 206-9.
  18. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil 1997; 78(1): 26-32.
  19. Dubey L, Karthikbabu S, Mohan D. Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: A randomized controlled trial. Ann Neurosci 2018; 25(2): 80-9.
  20. Naval DS, Nafeez S, Suruliraj K. Intra-rater and inter-rater reliability of measuring pelvic tilt using the palpation meter (PALMTM) device in stroke. Int J Med Health Sci 2016; 5(4): 276-80.
  21. Kumar SN, Omar B, Htwe O, Joseph LH, Krishnan J, Jafarzedah EA, et al. Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement. J Rehabil Res Dev 2014; 51(4): 591-8.
  22. Bohannon RW, Waldron RM. Weightbearing during comfortable stance in patients with stroke: Accuracy and reliability of measurements. Aust J Physiother 1991; 37(1): 19-22.
  23. Flansbjer UB, Holmback AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005; 37(2): 75-82.
  24. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003; 84(8): 1185-93.
  25. Nadeau S, Arsenault AB, Gravel D, Bourbonnais D. Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil 1999; 78(2): 123-30.
  26. Adegoke BO, Olaniyi O, Akosile CO. Weight bearing asymmetry and functional ambulation performance in stroke survivors. Glob J Health Sci 2012; 4(2): 87-94.
  27. Sackley CM. The relationships between weight-bearing asymmetry after stroke, motor function and activities of daily living. Physiother Theory Pract 1990; 6(4): 179-85.
  28. De Quervain IA, Simon SR, Leurgans S, Pease WS, McAllister D. Gait pattern in the early recovery period after stroke. J Bone Joint Surg Am 1996; 78(10): 1506-14.
  29. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke 1995; 26(6): 982-9.
  30. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: A systematic review. Stroke 2011; 42(5): 1482-8.
  31. Bohannon RW. Gait performance of hemiparetic stroke patients: selected variables. Arch Phys Med Rehabil 1987; 68(11): 777-81.
  32. Karthikbabu S, Chakrapani M, Ganesan S, Ellajosyla R. Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke. Neurol Clin Neurosci 2017; 5(1): 22-8.