Balance impairment limits ability to increase walking speed in individuals with chronic stroke

Middleton, Addie; H., Braun, Carty; Lewek, Michael D.; Fritz, Stacy L.

doi:10.3109/09638288.2016.1152603

Cited by 40 publications

(62 citation statements)

References 34 publications

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“…Consistent with the finding of the present study, other studies have also indicated that balance control (based on the BBS) is related to ambulatory function and has the ability to predict walking performance 4 , 16 , 17 , 18 , 19 , 20 ) . Although they have used different measuring tools for evaluating walking performance.…”

Section: Discussionsupporting

confidence: 93%

“…A majority of the gait cycle is spent in single leg stance and during this phase, the center of mass is traveled outside the margin of stability, thus making this phase inherently unstable, Therefore, balance recovery is critical to having a stable and safe ambulation. Following stroke, not only ambulation capacity is limited, but also due to weakness, spasticity and changes in muscle activation pattern, balance control is reduced 15 , 16 ) .…”

Section: Discussionmentioning

confidence: 99%

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Relationship between functional balance and walking ability in individuals with chronic stroke

et al. 2018

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[Purpose] The objective of this cross sectional study was to investigate the validity of Functional Ambulation Category in evaluating functional balance and identifying the relationship between balance impairment and functional ambulation in individuals with chronic stroke. [Participants and Methods] A total of 31 chronic stroke patients with first ever ischemic middle cerebral artery strokes, with no cognitive deficits were recruited. Participants had a mean age of 54.84 (SD=7.05) years and a time after stroke of 22.74 (SD=27.13) months. Community ambulation was determined by Functional Ambulation Category and functional balance was assessed by Berg Balance Scale. [Results] The mean Berg Balance Scale and the Functional Ambulation Category scores were 47.38 (SD=7.54) and 3.8 (SD=0.79), respectively. Correlation analysis revealed that balance impairment and ambulatory function was significantly positively correlated with each other (r=0.80). [Conclusion] The results shows that the Functional Ambulation Category is a valid tool in evaluating functional balance and suggest that functional balance may be an important goal for rehabilitation to achieve improvement in walking ability in people with chronic stroke.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Relationship between functional balance and walking ability in individuals with chronic stroke

et al. 2018

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“…This might be of relevance for clinicians as walking speeds and balance are well associated. 4,5 For example, if a patient achieves a score of 19 and greater on the Mini-BESTest but does not have walking speeds greater than 0.8 m/s, then this may indicate that individuals with stroke maybe slowing down their walking due to an underlying problem other than balance, such as strength deficits, fear of falling or cognitive processing. The clinician could use this information to target appropriate treatment activities to achieve faster walking speeds.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke

Madhavan

Bishnoi

2017

Topics in Stroke Rehabilitation

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Background The Mini-BESTest is a recently developed balance assessment tool that incorporates challenging dynamic balance tasks. Few studies have compared the psychometric properties of the Mini-BESTest to the commonly used Berg Balance Scale (BBS). However, the utility of these scales in relationship to post stroke walking speeds has not been explored. Objectives The purpose of this study was to compare the sensitivity and specificity of the Mini-BESTest and BBS to evaluate walking speeds in individuals with stroke. Design A retrospective exploratory design. Methods Forty-one individuals with chronic stroke were evaluated with the Mini-BESTest, BBS, and 10-meter self-selected walk test (10MWT). Based on their self-selected gait speeds (below or above 0.8 m/s), participants were classified as slow and fast walkers. Results Significant linear correlations were observed between the Mini-BESTest vs. BBS (r = 0.72, p ≤ 0.001), Mini-BESTest vs. 10MWT (r = 0.58, p ≤ 0.001), and BBS vs. 10MWT (r = 0.30, p = 0.05). Independent t-tests comparing the balance scores for the slow and fast walkers revealed significant group differences for the Mini-BESTest (p =0.003), but not for the BBS (p = 0.09). The Mini-BESTest demonstrated higher sensitivity (93%) and specificity (64%) compared to the BBS (sensitivity 81%, specificity 56%) for discriminating participants into slow and fast walkers. No significant results were observed with the FMLE-M scores. Conclusions The Mini-BESTest has a greater discriminative ability than the BBS to categorize individuals with stroke into slow and fast walkers.

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“…Given this variation in functional recovery, it is likely that a single MDC may be inappropriate for all individuals. In particular, slower walkers tend to have less gait speed reserve, 19 and thus may vary their gait speed less on a day to day basis. As a result, a slower walker may not need as large a change in gait speed as a faster walker to constitute a 'real' change.…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized that individuals with slower gait speeds would have smaller MDCs, due to the limited ability to vary gait speed compared to individuals with faster gait speeds. 19 It is important to present MDC's for a range of gait speeds, including the thresholds based on walking performance, 23 to inform future work.…”

Section: Introductionmentioning

confidence: 99%

Minimal Detectable Change for Gait Speed Depends on Baseline Speed in Individuals With Chronic Stroke

Lewek

Sykes

2019

Journal of Neurologic Physical Therapy

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Background and Purpose: Given the heterogeneity of mobility outcomes post-stroke, the purpose of this study was to examine how the minimal detectable change (MDC) for gait speed varies based on an individual's baseline walking speed. Methods: Seventy six participants with chronic stroke and able to walk without therapist assistance participated in two visits to record overground self-selected comfortable gait speed (CGS) and fast gait speed (FGS). Based on the CGS at visit one, participants were assigned to one of three speed groups: LOW (<0.4 m/s; N=32), MOD (0.4 m/s to 0.8 m/s; N=29), and HIGH functioning group (>0.8 m/s; N=15). Participants were then reclassified using updated gait speed cutoffs of 0.49 and 0.93 m/s. For each group, we determined test-retest reliability between visits, and the minimal detectable change for CGS and FGS. Results: Gait speed significantly increased from visit one to visit two for each group (p<0.001). The reliability for CGS declined with increasing gait speed, and MDC95 values increased with increasing gait speed (LOW: 0.10 m/s; MED: 0.15 m/s; HIGH: 0.18 m/s). Similar findings were observed for FGS, and when participants were recoded using alternative thresholds. Discussion and Conclusions: Slower walkers demonstrated greater consistency in walking speed from day to day, which contributed to a smaller MDC95 than faster walkers. These data will help researchers and clinicians adjust their expectations and goals when working with individuals with chronic stroke. Expectations for changing gait speed should be based on baseline gait speed, and will allow for more appropriate assessments of intervention outcomes.

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Balance impairment limits ability to increase walking speed in individuals with chronic stroke

Cited by 40 publications

References 34 publications

Relationship between functional balance and walking ability in individuals with chronic stroke

Relationship between functional balance and walking ability in individuals with chronic stroke

Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke

Minimal Detectable Change for Gait Speed Depends on Baseline Speed in Individuals With Chronic Stroke

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