{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T15:59:19Z","timestamp":1765382359463,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,30]],"date-time":"2022-01-30T00:00:00Z","timestamp":1643500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>Gait asymmetries are commonly observed in neurological populations and linked to decreased gait velocity, balance decrements, increased fall risk, and heightened metabolic cost. Interventions designed to improve gait asymmetries have varying methods and results. The purpose of this systematic review was to investigate non-pharmacological interventions to improve gait asymmetries in neurological populations. Keyword searches were conducted using PubMed, CINAHL, and Academic Search Complete. The search yielded 14 studies for inclusion. Gait was assessed using 3D motion capture systems (n = 7), pressure-sensitive mats (e.g., GAITRite; n = 5), and positional sensors (n = 2). The gait variables most commonly analyzed for asymmetry were step length (n = 11), stance time (n = 9), and swing time (n = 5). Interventions to improve gait asymmetries predominantly used gait training techniques via a split-belt treadmill (n = 6), followed by insoles\/orthoses (n = 3). The literature suggests that a wide range of methods can be used to improve spatiotemporal asymmetries. However, future research should further examine kinematic and kinetic gait asymmetries. Additionally, researchers should explore the necessary frequency and duration of various intervention strategies to achieve the greatest improvement in gait asymmetries, and to determine the best symmetry equation for quantifying gait asymmetries.<\/jats:p>","DOI":"10.3390\/sym14020281","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T01:46:21Z","timestamp":1643593581000},"page":"281","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Systematic Review of Non-Pharmacological Interventions to Improve Gait Asymmetries in Neurological Populations"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2112-7954","authenticated-orcid":false,"given":"Krista","family":"Meder","sequence":"first","affiliation":[{"name":"Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27412, USA"}]},{"given":"Chanel","family":"LoJacono","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Missouri Southern State University, Joplin, MO 64801, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7256-4508","authenticated-orcid":false,"given":"Christopher","family":"Rhea","sequence":"additional","affiliation":[{"name":"Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27412, USA"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1249\/MSS.0b013e31825e1d31","article-title":"Strength Asymmetry Increases Gait Asymmetry and Variability in Older Women","volume":"44","author":"LaRoche","year":"2012","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.apmr.2007.08.142","article-title":"Gait Asymmetry in Community-Ambulating Stroke Survivors","volume":"89","author":"Patterson","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1007\/s00221-006-0676-3","article-title":"Gait Asymmetry in Patients with Parkinson\u2019s Disease and Elderly Fallers: When Does the Bilateral Coordination of Gait Require Attention?","volume":"177","author":"Yogev","year":"2007","journal-title":"Exp. Brain Res. Heidelb."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1123\/jab.2012-0208","article-title":"The Relationship between Spatiotemporal Gait Asymmetry and Balance in Individuals With Chronic Stroke","volume":"30","author":"Lewek","year":"2014","journal-title":"J. Appl. Biomech."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/S8756-3282(00)00374-4","article-title":"Ambulatory Level and Asymmetrical Weight Bearing after Stroke Affects Bone Loss in the Upper and Lower Part of the Femoral Neck Differently: Bone Adaptation after Decreased Mechanical Loading","volume":"27","author":"Crabtree","year":"2000","journal-title":"Bone"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1177\/1545968314552528","article-title":"Walking Speed and Step Length Asymmetry Modify the Energy Cost of Walking After Stroke","volume":"29","author":"Awad","year":"2015","journal-title":"Neurorehabil. Neural. Repair."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/1545968316675428","article-title":"Associations between Foot Placement Asymmetries and Metabolic Cost of Transport in Hemiparetic Gait","volume":"31","author":"Finley","year":"2017","journal-title":"Neurorehabil. Neural. Repair."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1177\/1545968318787913","article-title":"Individual Differences in Locomotor Function Predict the Capacity to Reduce Asymmetry and Modify the Energetic Cost of Walking Poststroke","volume":"32","author":"Finley","year":"2018","journal-title":"Neurorehabil. Neural. Repair."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wei, T.-S., Liu, P.-T., Chang, L.-W., and Liu, S.-Y. (2017). Gait Asymmetry, Ankle Spasticity, and Depression as Independent Predictors of Falls in Ambulatory Stroke Patients. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177136"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.gaitpost.2010.12.003","article-title":"Reliability and Clinical Correlates of 3D-Accelerometry Based Gait Analysis Outcomes According to Age and Fall-Risk","volume":"33","author":"Bautmans","year":"2011","journal-title":"Gait Posture"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mahlknecht, P., Kiechl, S., Bloem, B.R., Willeit, J., Scherfler, C., Gasperi, A., Rungger, G., Poewe, W., and Seppi, K. (2013). Prevalence and Burden of Gait Disorders in Elderly Men and Women Aged 60\u201397 Years: A Population-Based Study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0069627"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.bbr.2014.03.041","article-title":"Effects of Dopaminergic Therapy on Locomotor Adaptation and Adaptive Learning in Persons with Parkinson\u2019s Disease","volume":"268","author":"Roemmich","year":"2014","journal-title":"Behav. Brain Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S0022-510X(03)00104-7","article-title":"Gait Dynamics in Parkinson\u2019s Disease: Relationship to Parkinsonian Features, Falls and Response to Levodopa","volume":"212","author":"Schaafsma","year":"2003","journal-title":"J. Neurol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S1474-4422(15)00041-1","article-title":"Freezing of Gait: A Practical Approach to Management","volume":"14","author":"Nonnekes","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.2147\/RMHP.S291669","article-title":"Gait Analysis of Old Individuals with Mild Parkinsonian Signs and Those Individuals\u2019 Gait Performance Benefits Little from Levodopa","volume":"14","author":"Wu","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"406","DOI":"10.3389\/fneur.2017.00406","article-title":"L-DOPA and Freezing of Gait in Parkinson\u2019s Disease: Objective Assessment through a Wearable Wireless System","volume":"8","author":"Suppa","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S444","DOI":"10.1002\/mds.21984","article-title":"The Role of Gait Rhythmicity and Bilateral Coordination of Stepping in the Pathophysiology of Freezing of Gait in Parkinson\u2019s Disease","volume":"23","author":"Plotnik","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S101","DOI":"10.3233\/JPD-181464","article-title":"Towards Personalized Rehabilitation for Gait Impairments in Parkinson\u2019s Disease","volume":"8","author":"Nonnekes","year":"2018","journal-title":"J. Parkinsons Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Panero, E., Digo, E., Dimanico, U., Artusi, C.A., Zibetti, M., and Gastaldi, L. (2021, January 23\u201325). Effect of Deep Brain Stimulation Frequency on Gait Symmetry, Smoothness and Variability Using IMU. Proceedings of the 2021 IEEE International Symposium on Medical Measurements and Applications (MeMeA), Lausanne, Switzerland.","DOI":"10.1109\/MeMeA52024.2021.9478602"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1093\/brain\/awm035","article-title":"Locomotor Adaptation on a Split-Belt Treadmill Can Improve Walking Symmetry Post-Stroke","volume":"130","author":"Reisman","year":"2007","journal-title":"Brain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1177\/1545968309332880","article-title":"Split-Belt Treadmill Adaptation Transfers to Overground Walking in Persons Poststroke","volume":"23","author":"Reisman","year":"2009","journal-title":"Neurorehabil. Neural. Repair"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.clinph.2013.07.003","article-title":"Locomotor Adaptation and Locomotor Adaptive Learning in Parkinson\u2019s Disease and Normal Aging","volume":"125","author":"Roemmich","year":"2014","journal-title":"Clin. Neurophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.clinbiomech.2013.02.001","article-title":"Bilateral Coordination and Gait Symmetry after Body-Weight Supported Treadmill Training for Persons with Chronic Stroke","volume":"28","author":"Combs","year":"2013","journal-title":"Clin. Biomech."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/PHM.0b013e3181c1ea8a","article-title":"Immediate Effect of Lateral-Wedged Insole on Stance and Ambulation after Stroke","volume":"89","author":"Chen","year":"2010","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/MRR.0000000000000287","article-title":"The Effect of a Single Textured Insole in Gait Rehabilitation of Individuals with Stroke","volume":"41","author":"Aruin","year":"2018","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.pmrj.2009.09.012","article-title":"The Effect of an Ankle-Foot Orthosis on Temporal Spatial Parameters and Asymmetry of Gait in Hemiparetic Patients","volume":"1","author":"Esquenazi","year":"2009","journal-title":"PMR"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"375638","DOI":"10.1155\/2015\/375638","article-title":"A Portable Gait Asymmetry Rehabilitation System for Individuals with Stroke Using a Vibrotactile Feedback","volume":"2015","author":"Afzal","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1177\/0309364615596063","article-title":"Evaluation of Gait Symmetry in Poliomyelitis Subjects: Comparison of a Conventional Knee\u2013Ankle\u2013Foot Orthosis and a New Powered Knee\u2013Ankle\u2013Foot Orthosis","volume":"40","author":"Arazpour","year":"2016","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"154","DOI":"10.3138\/physio.61.3.154","article-title":"Immediate Effects of Cane Use on Gait Symmetry in Individuals with Subacute Stroke","volume":"61","author":"Beauchamp","year":"2009","journal-title":"Physiother. Can."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3233\/JPD-140430","article-title":"Symmetry Matched Auditory Cues Improve Gait Steadiness in Most People with Parkinson\u2019s Disease but Not in Healthy Older People","volume":"5","author":"Brodie","year":"2015","journal-title":"J. Parkinson\u2019s Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.gaitpost.2016.04.020","article-title":"Split-Belt Locomotion in Parkinson\u2019s Disease Links Asymmetry, Dyscoordination and Sequence Effect","volume":"48","author":"Fasano","year":"2016","journal-title":"Gait Posture"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"474","DOI":"10.2522\/ptj.20080237","article-title":"Rapid and Long-Term Adaptations in Gait Symmetry Following Unilateral Step Training in People with Hemiparesis","volume":"89","author":"Kahn","year":"2009","journal-title":"Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"748","DOI":"10.2522\/ptj.20110206","article-title":"Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series","volume":"92","author":"Lewek","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/0269215517723056","article-title":"The Role of Movement Errors in Modifying Spatiotemporal Gait Asymmetry Post Stroke: A Randomized Controlled Trial","volume":"32","author":"Lewek","year":"2018","journal-title":"Clin. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.gaitpost.2020.02.016","article-title":"Gait Asymmetry Pattern Following Stroke Determines Acute Response to Locomotor Task","volume":"77","author":"Little","year":"2020","journal-title":"Gait Posture"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2798","DOI":"10.1080\/09638288.2017.1362477","article-title":"A Textured Insole Improves Gait Symmetry in Individuals with Stroke","volume":"40","author":"Ma","year":"2018","journal-title":"Disabil. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jelekin.2018.04.008","article-title":"More Symmetrical Gait after Split-Belt Treadmill Walking Does Not Modify Dynamic and Postural Balance in Individuals Post-Stroke","volume":"41","author":"Betschart","year":"2018","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12984-020-00732-z","article-title":"Persons Post-Stroke Improve Step Length Symmetry by Walking Asymmetrically","volume":"17","author":"Padmanabhan","year":"2020","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.humov.2015.05.010","article-title":"Using Swing Resistance and Assistance to Improve Gait Symmetry in Individuals Post-Stroke","volume":"42","author":"Yen","year":"2015","journal-title":"Hum. Mov. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Zanardi, A.P.J., Martinez, F.G., da Silva, E.S., Casal, M.Z., Martins, V.F., Passos-Monteiro, E., Haas, A.N., and Peyr\u00e9-Tartaruga, L.A. (2019). Effects of Nordic Walking on Gait Symmetry in Mild Parkinson\u2019s Disease. Symmetry, 11.","DOI":"10.3390\/sym11121481"},{"key":"ref_42","first-page":"29","article-title":"Comparison of Four Methods of Calculating the Symmetry of Spatial-Temporal Parameters of Gait","volume":"16","author":"Wiszomirska","year":"2014","journal-title":"Acta Bioeng. Biomech."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.gaitpost.2009.10.014","article-title":"Evaluation of Gait Symmetry after Stroke: A Comparison of Current Methods and Recommendations for Standardization","volume":"31","author":"Patterson","year":"2010","journal-title":"Gait Posture"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.bspc.2018.01.013","article-title":"Gait Symmetry Measures: A Review of Current and Prospective Methods","volume":"42","author":"Viteckova","year":"2018","journal-title":"Biomed. Signal. Process. Control."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"109531","DOI":"10.1016\/j.jbiomech.2019.109531","article-title":"A Novel Method for Measuring Asymmetry in Kinematic and Kinetic Variables: The Normalized Symmetry Index","volume":"99","author":"Queen","year":"2020","journal-title":"J. Biomech."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"579511","DOI":"10.3389\/fbioe.2020.579511","article-title":"Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces","volume":"8","author":"Alves","year":"2020","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.pmr.2015.06.010","article-title":"The Split-Belt Walking Paradigm: Exploring Motor Learning and Spatiotemporal Asymmetry Poststroke","volume":"26","author":"Helm","year":"2015","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.gaitpost.2009.06.017","article-title":"Effect of Treadmill Walking on the Stride Interval Dynamics of Human Gait","volume":"30","author":"Chang","year":"2009","journal-title":"Gait Posture"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1191\/0269215502cr512oa","article-title":"Prevalence of Spasticity Post Stroke","volume":"16","author":"Watkins","year":"2002","journal-title":"Clin. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1310\/tsr1605-346","article-title":"Understanding Motor Impairment in the Paretic Lower Limb after a Stroke: A Review of the Literature","volume":"16","author":"Arene","year":"2009","journal-title":"Top. Stroke Rehabil."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s007020170096","article-title":"Freezing of Gait in Patients with Advanced Parkinson\u2019s Disease","volume":"108","author":"Giladi","year":"2001","journal-title":"J. Neural. Transm."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.gaitpost.2017.07.107","article-title":"Gait Patterns in Association with Underlying Impairments in Polio Survivors with Calf Muscle Weakness","volume":"58","author":"Ploeger","year":"2017","journal-title":"Gait Posture"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.rehab.2009.10.002","article-title":"Aging and Sequelae of Poliomyelitis","volume":"53","author":"Laffont","year":"2010","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/NPT.0000000000000321","article-title":"Improving Spatiotemporal Gait Asymmetry Has Limited Functional Benefit for Individuals Poststroke","volume":"44","author":"Ryan","year":"2020","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2018.07.008","article-title":"Gait Characteristics and Falls in Parkinson\u2019s Disease: A Systematic Review and Meta-Analysis","volume":"57","author":"Creaby","year":"2018","journal-title":"Parkinsonism. Relat. Disord."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S1474-4422(19)30044-4","article-title":"Gait Impairments in Parkinson\u2019s Disease","volume":"18","author":"Mirelman","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2519\/jospt.2015.5540","article-title":"Altered Gait Characteristics in Individuals With Knee Osteoarthritis and Self-Reported Knee Instability","volume":"45","author":"Farrokhi","year":"2015","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"684","DOI":"10.4085\/1062-6050-478-17","article-title":"Altered Walking Neuromechanics in Patients with Chronic Ankle Instability","volume":"54","author":"Son","year":"2019","journal-title":"J. Athl. Train."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1161\/STROKEAHA.106.475921","article-title":"Improvements in Speed-Based Gait Classifications Are Meaningful","volume":"38","author":"Schmid","year":"2007","journal-title":"Stroke"}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/14\/2\/281\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:11:25Z","timestamp":1760134285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/14\/2\/281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,30]]},"references-count":59,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["sym14020281"],"URL":"https:\/\/doi.org\/10.3390\/sym14020281","relation":{},"ISSN":["2073-8994"],"issn-type":[{"type":"electronic","value":"2073-8994"}],"subject":[],"published":{"date-parts":[[2022,1,30]]}}}