Background: Comfortable gait speed after stroke is key to community ambulation, but the roles of step/stride-length mechanics, balance capacity, and balance confidence remain uncertain. Objects: To identify independent determinants of comfortable gait speed in ambulatory adults with chronic stroke and to clarify the roles of spatiotemporal gait mechanics and clinical balance measures. Methods: A cross-sectional secondary analysis was conducted in 40 inpatients classified as Functional Ambulation Category level 4. Comfortable overground speed from the 10-Meter Walk Test (10MWT) was the outcome. Candidate determinants were stride length, paretic step length, paretic single-limb support, Berg Balance Scale (BBS), limits-of-stability (LOS) area, center of pressure (COP) sway velocity, and Activities-specific Balance Confidence (ABC). Pearson correlations with Benjamini–Hochberg false discovery rate control were primary; Spearman’s ρ and partial correlations (adjusting for stride and paretic step length) tested robustness. Results: Speed was strongly correlated with stride length (r = 0.954) and paretic step length (r = 0.941), with balance capacity (BBS r = 0.916; LOS r = 0.868), and fell as sway increased (COP r = −0.878; all q < 0.001). Single-limb support showed a moderate link (r = 0.734), while ABC was essentially null. After accounting for stride and paretic step length, BBS, LOS, and COP still mattered; single-limb support and ABC did not. A sensitivity analysis using 10MWT time (s) as the outcome produced associations of similar magnitude: stride length and BBS, which were positively associated with gait speed, were negatively associated with time, whereas COP sway, which was negatively associated with gait speed, was positively associated with time. Conclusion: In ambulatory adults with chronic stroke, comfortable gait speed appears to be driven primarily by step/stride-length mechanics and objective balance capacity, whereas balance confidence did not add explanatory value in this cohort. Speed-focused rehabilitation may need to prioritize both step-length mechanics and balance capacity, while the role of confidence appears limited in this dataset.

The aim of the present study was to investigate age-related differences in stepping behavior in response to sensory perturbations of postural balance. The participants for this study were 2 healthy elderly adults (mean age=76.0) and 2 younger adults (mean age=25.5). Subjects were asked to step over a 10 cm high obstacle at self-paced speed with the right limb to land on the primary target (normal step length) that is 10 cm in diameter. However, if, during movement, the light was illuminated, then the subject had to step on the secondary target (long step length). It was planned that the onset of the light would be prior to peak Fx of swing limb, between swing peak Fx and swing toe-off, and after swing toe-off. In the younger adults these secondary visual cues were provided at mean times of 240 ms (standard deviation (SD)=11), 402 ms (SD=13), and 476 ms (SD=88) following the movement onset. Corresponding mean times for the healthy elderly were 150 ms (SD=67), 352 ms (SD=39), and 562 ms (SD=115). Results showed great changes in both group and visual cue condition in Fx ground reaction forces and temporal events following the swing toe-off. Swing limb acceleration force (Fx) and stance peak Fx1 was much greater in the young adults compared to the older adults. Both young and older adults increased stance peak Fx2 in the visual cue condition compared to normal stepping. There was no difference in stance peak Fx2 between the visual cue conditions in both groups. Similarly, the time to stance peak Fx2 was much longer for the visual cue condition than for the normal stepping. It was not different between the visual cue conditions in the young adults, but in the elderly mid and late cue was much greater than early cue. In addition, time to stance peak Fx2 and swing and stance time were much longer in the older adults compared to the young adults for the visual cue conditions. These results suggest that unlike young adults, elderly adults did not flexibly modify their responses to unexpected changes in step length while stepping over obstacles.