Characterizing Post-stroke Gait Propulsion Beyond Walking Speed: A Clinically Feasible Approach Using the Functional Gait Assessment

Post-stroke gait dysfunction is biomechanically heterogeneous, yet biomechanically-informed classifications of functional walking remain underdeveloped. In particular, there is a lack of clinically accessible methods for classifying gait deficits that account for propulsion impairments--a historically laboratory-dependent gait parameter requiring measurement with force plate systems. This study examined whether propulsion impairment can be classified by combining a global measure of walking function (i.e., the 10-meter walk test speed) with specific measures of dynamic walking ability derived from individual items of the Functional Gait Assessment (FGA). Forty participants >6 months poststroke completed biomechanical evaluations quantifying propulsion during walking and clinical assessments including the FGA. Multivariable stepwise regression identified the FGA items most strongly associated with paretic propulsion. Models augmented with these FGA items explained 10-14% greater variance in propulsion peak and 2-5% greater variance in propulsion impulse compared with models using walking speed alone. Incorporating FGA items also yielded the highest overall accuracy (72.5%) and per-class performance in propulsion severity classification. These findings establish the co-assessment of walking speed and targeted FGA items as a clinically-feasible approach to biomechanically-informed classification of post-stroke gait dysfunction.