Hemiparetic gait is characterised by temporal asymmetry and variability, and these variables are improved by auditory cueing. Stepping in place incorporates aspects of gait and may be a useful tool for locomotor training. The aim of this pilot study was to investigate the use of a single-tone and dual-tone metronome to cue stepping in place after hemiparetic stroke. Eight participants completed an uncued baseline stepping condition and two cued stepping conditions utilising a single-tone and a dual-tone metronome. Step times were determined from force plate data, and asymmetry and variability were calculated for the three conditions. Step time asymmetry was significantly reduced in the single-tone condition compared to baseline, and paretic step time variability was significantly reduced in both cued conditions. The single-tone metronome appeared to be preferred to the dual-tone metronome based on participant feedback. The results of this pilot study suggest that metronome cueing produces similar benefits on stepping in place to previously reported findings in walking. Further research on whether stepping in place to a metronome can be used for locomotor training is needed. 1. Introduction Hemiparetic gait is characterised by several specific deficits, including decreased walking speed [1], increased variability [2], and asymmetrical stepping [3, 4]. Understanding and rehabilitating these features of hemiparetic gait are of paramount importance as walking affords a considerable level of independence and thus a better quality of life for many stroke survivors [5]. Temporal asymmetry is a common characteristic of hemiparetic walking, even amongst independent ambulators [6], is very resistant to rehabilitation efforts [7], and appears to progress in later stages after stroke [8]. Temporal asymmetry is associated with increased vertical ground reaction forces through the nonparetic limb [9], and repeated higher forces over prolonged periods increase the risk of joint pain [10] and degeneration [11]. Temporal asymmetry is associated with decreased performance on clinical balance tests [12] and therefore may be linked to the increased risk of falling observed after stroke. Increases in the variability of gait parameters is of concern as only a small increase in stride time variability is associated with a risk of future falls [13]. Greater intraindividual variability in step length and double support time is linearly associated with increased risk of multiple falls in older adults, with a nonlinear association for step time variability [14]. Gait variability
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