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

Abstract

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.