Rhythm Perception and Production Abilities and Their Relationship to Gait After Stroke.

OBJECTIVES: To assess rhythm abilities, to describe their relation to clinical presentation, and to determine if rhythm production independently contributes to temporal gait asymmetry (TGA) poststroke. DESIGN: Cross-sectional. SETTING: Large urban rehabilitation hospital and university. PARTICIPANTS: Individuals (N=60) with subacute and chronic stroke (n=39) and data for healthy adults extracted from a preexisting database (n=21). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stroke group: National Institutes of Health Stroke Scale (NIHSS), Chedoke-McMaster Stroke Assessment (CMSA) leg and foot scales, Montreal Cognitive Assessment (MoCA), rhythm perception and production (Beat Alignment Test [BAT]), and spatiotemporal gait parameters were assessed. TGA was quantified with the swing time symmetry ratio. Healthy group: age and beat perception scores assessed by the BAT. Rhythm perception of the stroke group and healthy adults was compared with analysis of variance. Spearman correlations quantified the relation between rhythm perception and production abilities and clinical measures. Multiple linear regression assessed the contribution of rhythm production along with motor impairment and time poststroke to TGA. RESULTS: Rhythm perception in the stroke group was worse than healthy adults (F1,56=17.5, P=.0001) Within the stroke group, rhythm perception was significantly correlated with CMSA leg (Spearman ρ=.33, P=.04), and foot (Spearman ρ=.49, P=.002) scores but not NIHSS or MoCA scores. The model for TGA was significant (F3,35=12.8, P<.0001) with CMSA leg scores, time poststroke, and asynchrony of rhythm production explaining 52% of the variance. CONCLUSIONS: Rhythm perception is impaired after stroke, and temporal gait asymmetry relates to impairments in producing rhythmic movement. These results may have implications for the use of auditory rhythmic stimuli to cue motor responses poststroke. Future work will explore brain responses to rhythm processing poststroke.

Do Sex Offenders Have Higher Levels of Testosterone? Results From a Meta-Analysis.

The purpose of the current study is to review the available scientific evidence on the relationship between testosterone and sexual aggression. A systematic search for all primary studies comparing basal testosterone levels in sex offenders and non-sex offenders was undertaken across 20 electronic databases using an explicit search strategy and inclusion/exclusion criteria. A total of seven studies were identified and 11 effect sizes were computed; effects were pooled using both fixed and random effects meta-analysis models. Although individual study findings present a mix of results wherein sex offenders have higher or lower baseline levels of testosterone than non-sex offenders, pooled results indicate no overall difference between groups. Moderators of the analyses suggest possibly lower rates of testosterone in child molesters than controls; however, results are dependent on study weighting. Limitations, policy implications with respect to chemical castration laws, and future directions for research are discussed.

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke.

BACKGROUND: Reduced balance confidence is associated with impairments in features of balance and gait in individuals with subacute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify the relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. METHODS: Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months postdischarge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable, and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. RESULTS: Walking velocity was positively correlated with balance confidence, whereas mediolateral center of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. CONCLUSIONS: This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs.

A Jury of Their Peers: A Meta-Analysis of the Effects of Teen Court on Criminal Recidivism.

Juvenile delinquency has been on the decline for a number of years, yet, juvenile courts continue to assess more than 1 million cases per year. Involvement with the juvenile justice system has been linked to a number of risk factors and consequences that may impact positive youth development; however, evidence-based correctional programs that divert juvenile offenders away from formal processing are limited. Teen Court is a specialized diversion intervention that offers an alternative to traditional court processing for juvenile offenders. Despite the rapid expansion of Teen Courts, there is little comprehensive and systematic evidence available to justify this expansion. This meta-analytic study examines the effects of Teen Court on the recidivism of juvenile offenders. The literature search resulted in the selection of 14 studies, which contributed 18 unique effect sizes with a total sample of 2125 treatment group and 979 comparison group youth. The findings suggest that Teen Court is no more effective at reducing recidivism than (a) formal processing or (b) other diversion programs. Implications of formal and informal court processing for low-risk, first-time young offenders are discussed. The authors draw on the Risk-Need-Responsivity model to provide recommendations for policies and practices.

Do Falls Experienced During Inpatient Stroke Rehabilitation Affect Length of Stay, Functional Status, and Discharge Destination?

OBJECTIVE: To compare length of stay, functional status, and discharge destination between individuals who fell during inpatient stroke rehabilitation and those who did not fall. DESIGN: Retrospective cohort study. SETTING: Rehabilitation hospital. PARTICIPANTS: Individuals who fell during inpatient stroke rehabilitation (n=106; fallers group; mean age, 67.8±12.9y; mean time poststroke, 26.4±28.3d) were matched to individuals who did not fall (n=106; nonfallers group; mean age, 67.3±13.6y; mean time poststroke, 21.9±28.8d) on age and functional status (N=212). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Total length of stay, FIM assessed at discharge, and discharge destination. RESULTS: The mean length of stay for fallers was 11 days longer than nonfallers (P=.0017). Nonfallers and fallers did not differ on discharge total FIM scores (P=.19), and both groups were discharged home after inpatient rehabilitation (nonfallers: 77%; fallers: 74%; P=.52). CONCLUSIONS: This study suggests that falls experienced during inpatient stroke rehabilitation may have contributed to a longer length of stay; however, falls did not affect discharge functional status or discharge destination.

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation.

BACKGROUND: Falls are common among community-dwelling stroke survivors. The aims of this study were (1) to compare motor and cognitive outcomes between individuals who fell in the 6 months' postdischarge from in-patient stroke rehabilitation and those who did not fall, and (2) to explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function. METHODS: Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a 6-month falls monitoring period using postcards with follow-up. Nonfallers and fallers were compared at the 6-month follow-up assessment on the Berg Balance Scale (BBS), the Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and the Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed. RESULTS: Twenty-three fallers were matched to 23 nonfallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (P = .0066) and CMSA foot scores (P = .0033) were significantly lower for fallers than for nonfallers. The 2 groups did not differ on CMSA leg scores (P = .049), gait speed (P = .47), or MoCA score (P = .23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r = .27, P = .08). CONCLUSIONS: Performance in balance and motor recovery of the foot were compromised in fallers when compared to nonfallers at 6 months post discharge from in-patient stroke rehabilitation.

Carbon monoxide and ST-elevation myocardial infarction: case reports.

We describe two cases of myocardial infarction with ST-segment elevation on electrocardiogram associated with carbon monoxide (CO) poisoning, a condition rarely reported in the literature. The first was a 62-year-old woman who experienced chest pain in the emergency department (ED) while being assessed for exposure to carbon monoxide in her home. The second was an 80-year-old man who fainted at home and was found to have ST elevation during the ED workup. After hospitalization, he returned home and soon thereafter had difficulty walking and speaking. The responding paramedics detected a very high CO level in the home. Both patients received hyperbaric oxygen therapy within the first several hours of presentation. For this combination of conditions, it is difficult to derive evidence-based management recommendations, given the paucity of cases reported to date. We conclude that rapid consultation with interventional cardiology and consideration of angioplasty or stenting are appropriate, especially when electrocardiographic findings and echocardiography point to a specific coronary distribution. Hyperbaric oxygen therapy might have a role in the treatment, based on its effects on myocardial ischemia and injury in other models.

Does participation in standardized aerobic fitness training during inpatient stroke rehabilitation promote engagement in aerobic exercise after discharge? A cohort study.

OBJECTIVE: To determine whether attending an aerobic fitness program during inpatient stroke rehabilitation is associated with increased participation in physical activity after discharge. DESIGN: This was a prospective cohort study. Patients who received inpatient stroke rehabilitation and were discharged into the community (n = 61; mean age, 65 years) were recruited. Thirty-five participants attended a standardized aerobic fitness program during inpatient rehabilitation, whereas 26 did not. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and adherence to the American College of Sports Medicine (ACSM) guidelines were assessed up to 6 months after discharge. RESULTS: Participants in the fitness group had PASIPD scores and adherence to ACSM guidelines similar to those of participants in the nonfitness group up to 6 months after discharge. There was no significant correlation between volume of exercise performed during the inpatient program and amount of physical activity after discharge. CONCLUSION: Participation in an inpatient fitness program did not increase participation in physical activity after discharge in individuals with stroke. A new model of care that encourages patients to pursue physical activity after discharge and reduces the potential barriers to participation should be developed.

The effects of aftercare/resettlement services on crime and violence in children and youth: A systematic review.

Background: High rates of youth re-offending indicate that young custody-leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre-, during, and post-release and generally provide multiple forms of support services to address youths' transitional needs. Objectives: The present review examines (1) the impact of youth aftercare/resettlement programs on crime-related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost. Search Methods: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well-known researchers in the field. The search was completed in January 2023. Selection Criteria: For objectives 1-3, studies were included if they utilized a randomized controlled design or quasi-experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual-measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1-4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered. Data Collection and Analysis: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross-checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS-I (Sterne et al., 2016), ROB-2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1-3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta-regression. Thematic and narrative analysis was conducted to address objectives 4-6. Results: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = -1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis. Authors' Conclusions: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime-related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects.

Using wireless technology in clinical practice: does feedback of daily walking activity improve walking outcomes of individuals receiving rehabilitation post-stroke? Study protocol for a randomized controlled trial.

BACKGROUND: Regaining independent ambulation is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The feedback from these devices can be downloaded to a computer to produce reports. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke. METHODS: Participants will be randomly assigned to one of two groups: feedback or no feedback. Participants will wear accelerometers daily during in- and out-patient rehabilitation and, for participants in the feedback group, the participants' treating physiotherapist will receive regular reports of walking activity. The primary outcome measures are the amount of daily walking completed, as measured using the accelerometers, and spatio-temporal characteristics of walking (e.g. walking speed). We will also examine goal attainment, satisfaction with progress towards goals, stroke self-efficacy, and community-integration. DISCUSSION: Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge. In addition, a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge. TRIAL REGISTRATION: ClinicalTrials.gov NCT01521234.

Do Meta-Analyses of Intervention/Prevention Programs in the Field of Criminology Meet the Tests of Transparency and Reproducibility?

While assessments of transparent reporting practices in meta-analyses are not uncommon in the field of health sciences interventions, they are limited in the social sciences and to our knowledge are non-existent in criminology. Modified PRISMA 2020 checklists were used to assess transparency and reproducibility of reporting for a sample of 33 meta-analyses of intervention/prevention evaluations published in scholarly journals between 2016 and 2021. Results indicate that the average rate of transparent reporting practices was 63%; adherence varied considerably across studies and subscales, with low rates of adherence for some core checklist items. Overwhelmingly, studies were not reproducible in their entirety; article word count was significantly correlated with reproducibility (r = 0.4028, p < .03). These findings suggest that substantial changes to reporting practices are necessary to meet traditional meta-analytic claims of transparency and reproducibility. Study limitations include sample size, coding instruments, and coding subjectivity.

The Effectiveness of College Dating Violence Prevention Programs: A Meta-Analysis.

Due in part to their involvement with social activities on campus, college students experience an increased risk of dating violence. Recent legislation such as the Campus SaVE Act (which requires U.S. colleges to offer training on sexual assault, domestic violence, stalking, and sexual harassment to all incoming students) has contributed to the increase in prevention programming offered across postsecondary campuses, as well as subsequent research examining the effectiveness of these prevention efforts. The current study provides a systematic review and meta-analysis of college dating violence prevention programs. A systematic search of 28 databases and numerous gray literature sources identified an initial 14,540 articles of which 315 were deemed potentially eligible for inclusion. Studies were selected if they (1) evaluated a college dating prevention program/campaign, (2) reported one of five outcomes (knowledge, attitudes, or bystander efficacy, intentions, or behavior), (3) had a minimum sample size of 20 in the treatment group, (4) used a pre/post and/or comparison group design, and (5) were published in English or French between January 2000 and October 2020. We calculated 53 effect sizes from 31 studies and conducted separate meta-analyses on various categories of outcome measures. Findings suggest that college dating violence prevention programs are effective at increasing knowledge and attitudes toward dating violence, as well as bystander skills, but are not effective at increasing bystander behaviors. Findings from moderator analyses suggest that several program components influence the strength of treatment effects. Implications for improving the effectiveness of college dating violence prevention programs are discussed.

A Popular Approach, but Do They Work? A Systematic Review of Social Marketing Campaigns to Prevent Sexual Violence on College Campuses.

College campuses continue to face high rates of sexual violence and social marketing campaigns have emerged as a common prevention strategy. However, there exists no summative research examining the effectiveness of this approach. A systematic search yielded 15 evaluations of eight unique prevention campaigns, which contributed to 38 individual outcome measures across four outcome categories (i.e., knowledge, attitudes, intentions/efficacy, and behavior). Summative results are mixed, but show promising campaign effects for increasing knowledge, modification of some attitudes toward sexual violence, intentions to participate, and actual participation in prevention activities. More evaluative research is needed for a comprehensive understanding of campaign effectiveness.

Fostering college students' responsibility as prosocial bystanders to sexual violence prevention: A meta-analysis of the Bringing in the Bystander program.

Objective: To synthesize research examining the effectiveness of the sexual violence bystander program Bringing in the Bystander (BitB). Participants: The analytic sample included 2083 youth in the treatment group and 969 in the comparison group. Method: A search strategy that included a total of 45 search terms was applied to 28 electronic databases. Results: The systematic search yielded a final analytic sample of 14 evaluations, with 38 independent effect sizes calculated across four outcome measures: rape myth attitudes (n = 11), bystander efficacy (n = 11), bystander intentions (n = 11), and bystander behavior (n = 5). The BitB program produced significant, positive pooled effects on measures of rape-supportive attitudes, bystander efficacy, and bystander intentions. Conclusions: The overall results are promising and suggest that the BitB education program may be an effective tool for targeting sexual violence on campuses.

PROTOCOL: The effects of resettlement/re-entry services on crime and violence in children and youth: A systematic review.

This is the protocol for a Campbell systematic review. The goal of the study is to examine the impacts of aftercare/resettlement interventions on youth with respect to criminogenic outcomes, and to examine factors related to intervention success. Specific objectives are as follows: (1) What is the impact of aftercare/resettlement interventions on youth with respect to outcomes of crime and violence? (2) How is the treatment effect of aftercare/resettlement interventions on crime and violence outcomes moderated by factors such as participant (e.g., age, race, ethnicity, sex, offender type), treatment (e.g., intensity and quality of implementation), methodological (e.g., measurement of crime, study design, timing of follow-up measures), and study characteristics (e.g., date of publication, peer-reviewed status)? (3) Are some types of aftercare/resettlement interventions more effective than others? (4) What are the barriers and facilitators to effective implementation of aftercare/resettlement interventions? (5) What are the mechanisms (theory of change) underlying aftercare/resettlement interventions? (6) What does the available research suggest regarding the cost of aftercare/resettlement interventions?

Pathways to Engagement: An Exploratory Qualitative Analysis of Factors That Facilitate Men's Engagement in IPV Intervention Programs.

Research on intimate partner violence (IPV) interventions has long indicated mixed support for their effectiveness at reducing abusive behaviors. Limited prior research has focused on factors associated with participant engagement in the treatment process. Using a qualitative thematic analysis and a sample of 180 participants who completed an IPV intervention program, the purpose of this study was to identify key factors that facilitate men's responsiveness to IPV intervention programs. The findings highlight several commonalities in participants' perceptions of pathways that facilitated and/or hindered their engagement in the treatment process, and provide insights into how program/process elements can be structured to enhance engagement.

Extra! Extra! The Importance of Victim-Offender Relationship in Homicide Newsworthiness.

Domestic violence is a widespread issue, with victims suffering emotional and physical harm and severe cases resulting in homicide. Media presentation of extreme instances of domestic homicide may affect public opinion and related public policies. This study examines the presentation of homicide in print news media in the context of victim-offender relationship (domestic vs. non-domestic) using measures of article prominence. The sample includes articles published in the Vancouver Sun over a 12-year period (2004-2015) that reported on a homicide in British Columbia, Canada, with nature of the victim-offender relationship specified (n = 3,877). Results show that domestic-related homicides are reported less prominently than are non-domestic homicides, including being shorter in length, less likely to be placed on the front page, and less likely to include an image. Results are discussed in light of media impact on public opinion and the influence on public efforts to address and prevent the consequences of domestic violence.

99 Reasons and He Ain't One: A Content Analysis of Domestic Homicide News Coverage.

Domestic violence is a widespread issue, with victims suffering emotional and physical harm and severe cases resulting in homicide. Media presentation of these extreme instances may affect public opinion and related policies. The current study considered the portrayal of domestic homicides in Canadian print news, using articles published in the Vancouver Sun between 2004 and 2015. A content analysis shows domestic homicides were portrayed as isolated incidents and perpetuated the notions of victim blaming and offender excusing, rather than as connected to a pattern of domestic violence. This portrayal may affect how domestic violence and homicides are perceived and addressed.

An Initial Investigation of the Responsiveness of Temporal Gait Asymmetry to Rhythmic Auditory Stimulation and the Relationship to Rhythm Ability Following Stroke.

Temporal gait asymmetry (TGA) is a persistent post-stroke gait deficit. Compared to conventional gait training techniques, rhythmic auditory stimulation (RAS; i.e., walking to a metronome) has demonstrated positive effects on post-stroke TGA. Responsiveness of TGA to RAS may be related to several factors including motor impairment, time post-stroke, and individual rhythm abilities. The purpose of this study was to investigate the relationship between rhythm abilities and responsiveness of TGA when walking to RAS. Assessed using behavioral tests of beat perception and production, participants with post-stroke TGA (measured as single limb support time ratio) were categorized according to rhythm ability (as strong or weak beat perceivers/producers). We assessed change in TGA between walking without cues (baseline) and walking while synchronizing footsteps with metronome cues. Most individuals with stroke were able to maintain or improve TGA with a single session of RAS. Within-group analyses revealed a difference between strong and weak rhythm ability groups. Strong beat perceivers and producers showed significant reduction (improvement) in TGA with the metronome. Those with weak ability did not and exhibited high variability in the TGA response to metronome. Moreover, individuals who worsened in TGA when walking to metronome had poorer beat production scores than those who did not change in TGA. However, no interaction between TGA improvement when walking to metronome and rhythm perception or production ability was found. While responsiveness of TGA to RAS did not significantly differ based on strength of rhythm abilities, these preliminary findings highlight rhythm ability as a potential consideration when treating post-stroke individuals with rhythm-based treatments.

Longitudinal change in spatiotemporal gait symmetry after discharge from inpatient stroke rehabilitation.

Purpose: To describe the change in spatiotemporal gait asymmetry after discharge from stroke rehabilitation and examine the relationship with change in other clinical outcome measures.Methods: Secondary analysis of a prospective cohort study was conducted. Swing time and step length symmetry, balance, mobility, gait speed, and motor impairment were assessed at discharge and 6 months later. Participants (n = 61) were classified by shift in symmetry status (Asymmetric-to-Symmetric, Symmetric-to-Asymmetric, No Shift) and magnitude of difference scores (Improved, Worse, No Difference). Correlations between change in spatiotemporal symmetry and the other clinical measures of physical status were calculated.Results: At discharge, 61% (37/61) and 36% (22/61) of participants were asymmetric in swing time and step length, respectively. Of this subgroup, 43% (16/37) and 50% (11/22) shifted to symmetric gait by follow-up. In contrast, only six individuals significantly improved in swing and/or step symmetry according to minimal detectable change. Change in spatiotemporal symmetry was not significantly correlated with change in the clinical outcome measures.Conclusions: Despite overall gains in physical function and decreased prevalence of asymmetry, most individuals with stroke do not improve in swing or step symmetry following discharge from rehabilitation. Further research is necessary to elucidate factors that affect recovery of gait quality.Implications for rehabilitationAsymmetric gait after stroke is a major concern for patients and their therapists but can be resistant to intervention.Spatiotemporal asymmetry persists for many individuals following discharge from hospital stay despite improvement in other gait-related measures.While the determinants of change remain unclear, gait quality should be specifically monitored and addressed to avoid long-term negative effects.