Associations between changes in gait parameters, balance, and walking capacity during the first 3 months after stroke: a prospective observational study

Abstract

Background: Independent ambulation is a common rehabilitation goal after stroke, requiring adequate balance and efficiency of gait. Spatiotemporal gait parameters are expected to improve in the first 3 months and their association with balance and efficiency of gait may provide useful insights into the recovery of safe and independent mobility. Objective: Examine the associations between changes in spatiotemporal gait parameters, balance, and walking capacity during the first 3 months after stroke. Methods: This prospective observational study included participants diagnosed with stroke. Within the first 2 weeks after stroke onset and again 3 months (±2 weeks) later, gait was assessed using a GAITRite mat at self-selected gait speed, balance using the Berg Balance Scale (BBS), and walking capacity using the 6-minute walk test (6 MWT). Changes in gait parameters, balance, and walking capacity were assessed using paired sample t-tests, and linear regression analyses were used to assess associations between changes in spatiotemporal gait parameters, BBS, and 6MWT. Results: Seventy-nine participants (mean (SD) age 75.4 (8.5) years; 44 men) were included. Gait parameters, balance, and walking capacity all improved during follow-up. The bivariate regression analyses showed associations between improvements in all gait parameters, except walk ratio, with improvement in balance, and in all gait parameters with improvement in walking capacity. Only gait speed was associated with balance (13.8 points, 95% CI 0.5, 27.8, p = .0042) and walking capacity (256 m, 95% CI 173,340, p < .001) in the multivariate analyses. Conclusion: Improved spatiotemporal gait parameters were associated with improved balance and walking capacity within the first 3 months after stroke.

Agreement, Reliability, and Concurrent Validity of an Outdoor, Wearable-Based Walk Ratio Assessment in Healthy Adults and Chronic Stroke Survivors

“…Previous findings informed our hypothesis that chronic stroke survivors may have a lower WR than healthy adults ( Kalron, 2016 ; Norvang et al, 2020 ). Indeed, we found significantly lower WR values in stroke survivors compared to healthy adults, despite our stroke sample being rather well-rehabilitated ( Table 1 , MoCA, mRS, FAC).…”

“…The following variables were entered as predictor variables in the model in three blocks: 1) stroke (dichotomous, yes or no) and MoCA score, 2) gait speed < 1 m/s (dichotomous, yes or no) and pain in the lower extremities and back (dichotomous, yes or no), and 3) age and gender. Neurological disorders such as stroke have been reported to alter the WR ( Kalron, 2016 ; Norvang et al, 2020 ), therefore, we entered the predictor “stroke—yes or no” in the first model. The entry of the MoCA score into the first model was based on growing evidence that cognition plays a role in gait control in older adults and neurological patients ( Amboni et al, 2013 ).…”

“…Moreover, there may exist a “normal” WR range indicating healthy walking [evidence suggests an approximate range of 0.58–0.63 cm/step/min, ( Bogen et al, 2018 )]. In pathological contexts, however, the WR seems to be altered ( Kalron, 2016 ; Norvang et al, 2020 ). For instance, patients with subacute stroke or multiple sclerosis show lower WR values [0.53—0.58 cm/step/min, ( Kalron, 2016 ; Kalron et al, 2020 ; Norvang et al, 2020 )].…”

“…In pathological contexts, however, the WR seems to be altered ( Kalron, 2016 ; Norvang et al, 2020 ). For instance, patients with subacute stroke or multiple sclerosis show lower WR values [0.53—0.58 cm/step/min, ( Kalron, 2016 ; Kalron et al, 2020 ; Norvang et al, 2020 )]. The WR, thus, may be indicative of impaired and/or recovering gait ( Suzuki et al, 1999 ; Kalron, 2016 ).…”

Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis

“…Balance is the ability to use muscular forces to control the center of gravity both within and outside of the base of support [ 24 ]. Balance is one of the core determinants of independent gait [ 25 ] and quality of life [ 26 ] in the stroke population. During CIMT, when the upper extremity, trunk, or lower extremity is constrained, the patient is required to perform specific functional tasks prescribed by the therapist without the aid of the unaffected extremity.…”