Modeling the Heterogeneity of Post-Stroke Gait Control in Free-Living Environments Using a Personalized Causal Network

Post-stroke gait control is a complex, often fail to account for the heterogeneity and continuity of gait in existing gait models. Precisely evaluating gait speed adjustability and gait instability in free-living environments is important to understand how individuals with post-stroke gait dysfunction approach diverse environments and contexts. This study aimed to explore individual causal interactions in the free-living gait control of persons with stroke. To this end, fifty persons with stroke wore an accelerometer on the fifth lumbar vertebra (L5) for 24 h in a free-living environment. Individually directed acyclic graphs (DAGs) were generated based on the spatiotemporal gait parameters at contemporaneous and temporal points calculated from the acceleration data. Spectral clustering and Bayesian model comparison were used to characterize the DAGs. Finally, the DAG patterns were interpreted via Bayesian logistic analysis. Spectral clustering identified three optimal clusters from the DAGs. Cluster 1 included persons with moderate stroke who showed high gait asymmetry and gait instability and primarily adjusted gait speed based on cadence. Cluster 2 included individuals with mild stroke who primarily adjusted their gait speed based on step length. Cluster 3 comprised individuals with mild stroke who primarily adjusted their gait speed based on both step length and cadence. These three clusters could be accurately classified based on four variables: Ashman’s D for step velocity, Fugl-Meyer Assessment, step time asymmetry, and step length. The diverse DAG patterns of gait control identified suggest the heterogeneity of gait patterns and the functional diversity of persons with stroke. Understanding the theoretical interactions between gait functions will provide a foundation for highly tailored rehabilitation.