Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial.
9 affiliations
- 1Department of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- 2Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- 3Department of Exercise Rehabilitation & Welfare, Gachon University, Incheon, Republic of Korea.
- 4School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea.
- 5Department of Civil and Environmental Engineering, Yonsei University, Seoul, Republic of Korea.
- 6Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- 7Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
- 8Department of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. [email protected].
- 9Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. [email protected].
Abstract
Background
Step length asymmetry is a specific and persistent characteristic of hemiparetic gait in patients with chronic stroke, typically resulting from impaired weight bearing and reduced propulsive force on the paretic side. This asymmetry leads to reduced walking efficiency and an increased risk of musculoskeletal complications. This study investigated the efficacy of an anterioposterior weight-shift training (AP training) system utilizing visual biofeedback to improve gait asymmetry in patients with chronic stroke.Methods
This randomized controlled trial enrolled 34 patients with chronic hemiplegic stroke who exhibited step-length asymmetry (step-length ratio > 1.1). Participants were randomized into an AP training group or a control group. Both groups received conventional gait training for 6 weeks, and the experimental group received additional AP training sessions (30 min, 3 times/week). The AP training system provided real-time visual biofeedback on the Center of Pressure trajectory and weight distribution. The primary outcome was the Step Length Asymmetry Index (SLAI). The secondary outcomes included plantar pressure distribution, temporospatial parameters, 3D kinematic/kinetic gait analysis, and energy consumption.Results
The AP training group demonstrated significant improvements in the SLAI compared with the control group (p < 0.05). Significant between-group differences favoring the intervention were also observed for swing time asymmetry, forefoot contact area, and pressure (p < 0.05). Three-dimensional gait analysis revealed an increased ankle dorsiflexion angle and hip extension moment on the affected side in the training group. While the self-selected walking speed showed no significant difference, the maximum safe walking speed significantly improved in the training group (p < 0.05). No significant between-group differences were observed in energy consumption (oxygen cost or oxygen rate).Conclusion
AP training may effectively improve step length asymmetry and paretic limb mechanics in patients with chronic stroke. By enhancing the anterior weight transfer and propulsive force, this intervention offers a targeted strategy for addressing established asymmetric gait patterns in the chronic phase of recovery. Trial details ClinicalTrial.gov Identifier NCT02207933.
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BibTeX
@article{lee2026efficacy,
title = {{Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial.}},
author = {Jong Weon Lee and Yea Jin Jo and Yoon Su Baek and Seeun Kim and Jung Hoon Kim and Dae Hyun Kim and Jong Hyun Choi and Jong Bum Park and Deog Young Kim},
journal = {Journal of neuroengineering and rehabilitation},
year = {2026},
month = jul,
doi = {10.1186/s12984-026-02030-6},
url = {https://europepmc.org/article/MED/42897557},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial.
AU - Jong Weon Lee
AU - Yea Jin Jo
AU - Yoon Su Baek
AU - Seeun Kim
AU - Jung Hoon Kim
AU - Dae Hyun Kim
AU - Jong Hyun Choi
AU - Jong Bum Park
AU - Deog Young Kim
PY - 2026
DA - 2026/07/01
JO - Journal of neuroengineering and rehabilitation
DO - 10.1186/s12984-026-02030-6
UR - https://europepmc.org/article/MED/42897557
AB - Background Step length asymmetry is a specific and persistent characteristic of hemiparetic gait in patients with chronic stroke, typically resulting from impaired weight bearing and reduced propulsive force on the paretic side. This asymmetry leads to reduced walking efficiency and an increased risk of musculoskeletal complications. This study investigated the efficacy of an anterioposterior weight-shift training (AP training) system utilizing visual biofeedback to improve gait asymmetry in patients with chronic stroke.Methods This randomized controlled trial enrolled 34 patients with chronic hemiplegic stroke who exhibited step-length asymmetry (step-length ratio > 1.1). Participants were randomized into an AP training group or a control group. Both groups received conventional gait training for 6 weeks, and the experimental group received additional AP training sessions (30 min, 3 times/week). The AP training system provided real-time visual biofeedback on the Center of Pressure trajectory and weight distribution. The primary outcome was the Step Length Asymmetry Index (SLAI). The secondary outcomes included plantar pressure distribution, temporospatial parameters, 3D kinematic/kinetic gait analysis, and energy consumption.Results The AP training group demonstrated significant improvements in the SLAI compared with the control group (p < 0.05). Significant between-group differences favoring the intervention were also observed for swing time asymmetry, forefoot contact area, and pressure (p < 0.05). Three-dimensional gait analysis revealed an increased ankle dorsiflexion angle and hip extension moment on the affected side in the training group. While the self-selected walking speed showed no significant difference, the maximum safe walking speed significantly improved in the training group (p < 0.05). No significant between-group differences were observed in energy consumption (oxygen cost or oxygen rate).Conclusion AP training may effectively improve step length asymmetry and paretic limb mechanics in patients with chronic stroke. By enhancing the anterior weight transfer and propulsive force, this intervention offers a targeted strategy for addressing established asymmetric gait patterns in the chronic phase of recovery. Trial details ClinicalTrial.gov Identifier NCT02207933.
SN - 1743-0003
ER -