Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study

Abstract

Background Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. Objective The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months. Design This study was designed as an explorative longitudinal cohort study. Methods Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. Results This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85–0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. Limitations Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. Conclusion This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.

Factors Associated with Level of Physical Activity After Minor Stroke

“…In a previous publication, we showed although balance improved from acute phase to 12 months, one-in-four had impaired balance one year after minor stroke. 34 These balance impairments were mainly related to dynamic balance performance. Impairments in dynamic balance were also found in the study by Batchelor et a, where they compared people after minor stroke with age and sex matched controls.…”

Fatores clínicos e sociodemográficos associados a recuperação da marcha de indivíduos após acidente vascular cerebral trombolisado na fase aguda

“…19,22 A literatura aponta que o equilíbrio na fase aguda, é o principal preditor do equilíbrio após 12 meses do AVC, influenciando também na velocidade da marcha dos indivíduos. 23 Os resultados do presente estudo apontam que o equilíbrio na admissão hospitalar pode ser também um preditor para a marcha antes da alta, ainda na fase aguda da doença, ressaltando a importância da avaliação do equilíbrio precoce para um melhor manejo clínico e planejamento do programa de reabilitação. 24 O tabagismo é associado ao desenvolvimento de diversas doenças cardiovasculares assim como o AVC, além de DPOC e câncer, estando relacionada a um alto índice de mortalidade e incapacidade e um pior estado de saúde.…”

Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity

“…27 The TUG was specifically used to quantify functional mobility, 28 and the 10-MWT was used to asses comfortable walking speed, as 2 different aspects of gait capacity. 19 , 28 …”

“…27 The TUG was specifically used to quantify functional mobility, 28 and the 10-MWT was used to asses comfortable walking speed, as 2 different aspects of gait capacity. 19,28 Participant's balance confidence during common everyday activities was assessed with the 6-item short version of the ABC scale (6-ABC; range: 0%-100%), 29 with 100% representing full balance confidence.…”

“…15 While the literature on individuals with mild motor impairments after stroke is sparse, a few studies report impaired balance and gait capacity after mild stroke. [16][17][18][19] However, it remains unclear what the impact of these balance and gait limitations is in terms of falls and their consequences. We therefore conducted an observational case-control study of individuals in the chronic phase after mild stroke in which balance and gait capacity, balance confidence, and physical activity were measured along with a 12-month follow-up period of self-reported falls.…”