Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Hawkins, Kelly; Balasubramanian, Chitralakshmi K.; Vistamehr, Arian; Conroy, Christy; Rose, Dorian K.; Clark, David J.; Fox, Emily J.

doi:10.1080/10749357.2019.1609182

Cited by 18 publications

(17 citation statements)

References 34 publications

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“…This finding was similar to that reported in the previous study by Hsueh and colleagues 36. The stepping backward task assessed an uncommon pattern of walking, leading to an increased task difficulty, ie, stepping backward required postural balance and motor control to a greater extent than stepping forward 37. In addition, during “takes 3 steps backwards,” patients cannot use visual input to help control planning of foot placement 38.…”

Section: Discussionsupporting

confidence: 86%

“…36 The stepping backward task assessed an uncommon pattern of walking, leading to an increased task difficulty, ie, stepping backward required postural balance and motor control to a greater extent than stepping forward. 37 In addition, during "takes 3 steps backwards," patients cannot use visual input to help control planning of foot placement. 38 Similar to the previous study, 34,36 we found that "rolls onto side" was the easiest item.…”

Section: Discussionmentioning

confidence: 99%

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Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM

Winairuk

Chaikeeree

Sirisup

et al. 2021

Journal of Neurologic Physical Therapy

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Background and Purpose: Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. Methods: Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. Results: Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items “flexes hip and knee in supine” and “rolls onto side” were the easiest items, whereas the “dorsiflexes affected ankle with knee extended” item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. Discussion and Conclusions: Findings can be used in the assessment and treatment planning of persons with stroke. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM

Winairuk

Chaikeeree

Sirisup

et al. 2021

Journal of Neurologic Physical Therapy

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“…Accordingly, we expected that the age-related differences of the neuromuscular control of gait would be greatly evidenced during backward walking. Indeed, several findings support the idea that backward walking may unmask mobility impairments in adult stroke patients [ 43 ], Parkinson disease [ 93 ], and in children with cerebral palsy [ 42 ]. By comparing older to young adults, greater adjustments of spatiotemporal gait parameters have been observed during backward than forward walking [ 2 , 31 , 52 ].…”

Section: Discussionmentioning

confidence: 77%

Age-related changes in the neuromuscular control of forward and backward locomotion

et al. 2021

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Previous studies found significant modification in spatiotemporal parameters of backward walking in healthy older adults, but the age-related changes in the neuromuscular control have been considered to a lesser extent. The present study compared the intersegmental coordination, muscle activity and corresponding modifications of spinal montoneuronal output during both forward and backward walking in young and older adults. Ten older and ten young adults walked forward and backward on a treadmill at different speeds. Gait kinematics and EMG activity of 14 unilateral lower-limb muscles were recorded. As compared to young adults, the older ones used shorter steps, a more in-phase shank and foot motion, and the activity profiles of muscles innervated from the sacral segments were significantly wider in each walking condition. These findings highlight age-related changes in the neuromuscular control of both forward and backward walking. A striking feature of backward walking was the differential organization of the spinal output as compared to forward gait. In addition, the resulting spatiotemporal map patterns also characterized age-related changes of gait. Finally, modifications of the intersegmental coordination with aging were greater during backward walking. On the whole, the assessment of backward walk in addition to routine forward walk may help identifying or unmasking neuromuscular adjustments of gait to aging.

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“…First, this test measures balance when changing direction of gait (forward, to right, to left and backward), an important skill when walking in the community. 33 Second, to perform the FSST the individual needs to move away from the base of support. Others balance tests like BBS and POMA-B (Performance-Oriented Mobility Assessment - Balance) require minimal movement outside the base of support.…”

Section: Discussionmentioning

confidence: 99%

Deficits in dynamic balance were the motor impairments that best explained limitations in community ambulation after stroke

Alvarenga¹,

Avelino²,

Menezes³

et al. 2023

Eur J Phys Rehabil Med

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BACKGROUND Improving walking capacity, in order to achieve community ambulation, is an important goal for both patients and rehabilitation professionals. However, only about 7 to 27% of the stroke survivors will be able to walk in the community. AIM The aim of this study was to determine which measures of motor impairments would impair community ambulation in 90 individuals with chronic stroke. DESIGN Cross-sectional study. SETTING Research laboratory at Federal University of Minas Gerais. POPULATION Chronic stroke patients. METHODS For this exploratory study, the dependent variable, community ambulation, was determined by the distance covered during the 6-Minute Walking Test (6MWT). Participants, who covered ≥288 meters during the 6MWT, were classified as unlimited-community ambulators, whereas those who covered <288 meters were considered limited-community ambulators. Logistic regression analysis was carried-out to investigate which measures of motor impairments (deficits in strength of the knee extensor muscles, dynamic balance, and lower-limb motor coordination, as well as increased tonus of the ankle plantarflexor muscles) would explain the variance in community ambulation, i.e. , the distance covered during the 6MWT. RESULTS Out of the 90 participants, 51 were unlimited and 39 were limited-community ambulators. Only the measure of dynamic balance (OR=0.81, 95% CI: 0.72-0.91) reached significance and was kept in the logistic regression model. CONCLUSIONS Deficits in dynamic balance best explained limitations in community ambulation in individuals with chronic stroke. Future studies are needed to determine whether rehabilitation interventions aiming at improving dynamic balance would lead to unlimited-community ambulation. CLINICAL REHABILITATION IMPACT Amongst common motor impairments observed after stroke, such as increased tonus of the ankle plantarflexor muscles and deficits in strength of the knee extensor muscles and lower-limb motor coordination, dynamic balance, was the only variable that explained limitations in community ambulation after stroke. Future studies aiming at investigating community ambulation after stroke could take into account measures of dynamic balance.

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Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Cited by 18 publications

References 34 publications

Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM

Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM

Age-related changes in the neuromuscular control of forward and backward locomotion

Deficits in dynamic balance were the motor impairments that best explained limitations in community ambulation after stroke

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