## 4 Discussion

Table 3: Changes in gait parameters according to differences in walking speed (n = 24). phase, the gluteus medius contributes primarily to pelvic stabilization and mediolateral weight shifting rather than to forward propulsion [30; 31]. Previous studies reported that using walking aids can reduce gluteus medius activation by being substituted for weight-bearing demands, with the use of a cane reportedly decreasing muscle activity by approximately 22% [32; 33]. In this study, 13 of the 24 participants (55.17%) used a mono-cane during all walking trials. The observed decrease in gluteus medius activity across speed conditions may therefore show a shift in load-bearing responsibility from the muscle to the cane. In gait parameters, although both paretic (46.22 to 60.00 %height, 29.81%) and non-paretic (45.99 to 59.09 %height, 28.48%) stride lengths significantly increased with faster walking speeds (\(p<0.05\)), other gait parameters and gait asymmetry did not show noticeable improvement with changes in walking speed. This suggests that patients post-stroke maintained their baseline asymmetric gait pattern despite significantly increasing their stride length to cope with faster speeds. Greater gait asymmetry has been associated with a higher risk of falls in people with chronic stroke and with increased metabolic energy cost during walking. Thus, restoration of gait asymmetry has important clinical implications in stroke [34]. [PERSON] et al. found that increased walking speed did not necessarily indicate improved walking efficiency or symmetry [14]. In addition, another study reported that increased walking speed may not lead to improved symmetry, and faster walking may reinforce existing asymmetric gait patterns due to overuse of the non-paretic side [35]. Gait symmetry is more closely associated with neuromuscular factors such as balance, proprioception, and coordination than with simple elements such as muscle strength or walking speed [30; 36]. Moreover, gait symmetry refers to the balance between the left and right sides of the body while walking, including parameters such as stride length, stance time, and swing phase. Without sufficient recovery in these complex domains, improvements in gait symmetry through increased walking speed alone may be limited. Some studies have reported that increasing walking speed can improve certain gait parameters in patients post-stroke [13; 15; 37]; nonetheless, other evidence highlights the importance of task-specific interventions, including weight shifting, trunk rotation, and dual-task training [36]. Particularly, cognitive dual-task training--involving walking while performing a simultaneous mental task--enhances gait and balance more effectively than walking alone [38]. Therefore, restoring qualitative aspects, such as gait symmetry, necessitates a more comprehensive consideration of various influencing parameters. The results of the present study showed that the improvement of some lower extremity muscle activity and gait parameters by increasing walking speed may not affect the overall improvement of gait quality or symmetry; however, this study had some limitations that should be acknowledged. First, the number of participants was relatively small (24 patients who suffered chronic stroke), and the functional level was in the moderate category (average comfortable walking speed, 0.67 m/s; FAC, 2-4). This sample size limits the generalizability of the results to the broader stroke population, especially to those with mild impairment (who walk faster and more symmetrically) or severe impairment (who may not tolerate fast walking at all). Second, 55% of the participants in this study used a cane while walking. According to previous studies, patients who have had a stroke and use a cane tend to offload over 7% of their body weight onto the assistive device [39]. Therefore, using a cane may have introduced potential confounding effects on the study outcomes. Additionally, this study's small sample size prevented us from conducting subgroup analyses by cane use.