Volumes of intact gray matter outside the stroke predict gait performance

Experimental(1) and clinical evidence support right hemisphere dominance for postural control, given its specialized role in constructing and updating spatial references.(2,3) As a prerequisite for walking, this right hemisphere dominance for postural control should also affect gait.(4) In this issue of Neurology (R), Chen et al.(5) confirm this view and reveal that patients with a chronic right middle cerebral artery (MCA) infarct show slower and more asymmetrical gait as compared to those with a left MCA infarct and controls. Conclusions of this study are robust after controlling for possible confounding factors. Patients with a right (n = 19) or a left (n = 20) solitary infarct in the territory of the MCA showed similar poststroke duration (7.6 +/- 6.0 years), functional independence, and infarct size precisely quantified with a 3-T MRI. All were able to walk without assistance. Gait analysis was accurate and as naturalistic as possible, performed over 75 meters (indoor) at preferred speed, with plantar pressures measured by shoe insoles.