Association between Selective Motor Control of the Lower Limb and Gait Performance in Chronic Stroke Survivors: A Cross-Sectional Study

Abstract

Background: Impaired walking is among the most disabling consequences of stroke. Loss of selective motor control (SMC), the ability to move one joint without unwanted synergistic movement at others, may contribute to this impairment, but its link with clinically measured gait performance in the chronic phase is poorly defined.

Objective: To examine the association between lower-limb SMC and gait performance in people with chronic stroke.

Methods: In this hospital-based cross-sectional study, 101 adults aged 45–70 years, at least six months after a first unilateral stroke and able to walk 10 M independently, were recruited by convenience sampling. SMC of the paretic limb was rated with the Selective Control Assessment of the Lower Extremity (SCALE; 0–10). Gait speed (10-Meter Walk Test, 10MWT), functional mobility (Timed Up and Go, TUG) and walking endurance (6-Minute Walk Test, 6MWT) were measured. Associations were tested with Spearman correlation and multiple linear regression adjusted for age, time since stroke, spasticity and assistive-device use.

Results: The mean SCALE score was 5.4 ± 2.4. Higher SMC correlated with faster gait speed (ρ = 0.64), longer 6MWT distance (ρ = 0.53) and shorter TUG time (ρ = −0.70; all p < 0.001). After adjustment, SCALE remained independently associated with all three outcomes (standardised β = 0.70, 0.60 and −0.67, respectively; p < 0.001), explaining 32–51% of outcome variance. Participants with high SMC walked more than twice as fast as those with low SMC.

Conclusion: Lower-limb SMC is positively and independently associated with gait speed, endurance and functional mobility in chronic stroke. A simple bedside rating of SMC may help identify survivors whose walking limitations are driven by impaired movement selectivity and guide targeted rehabilitation. Longitudinal and interventional studies are needed to test causality.