Improvements in Speed-Based Gait Classifications Are Meaningful

Abstract

Background and Purpose-Gait velocity is a powerful indicator of function and prognosis after stroke. Gait velocity can be stratified into clinically meaningful functional ambulation classes, such as household ambulation (Ͻ0.4 m/s), limited community ambulation (0.4 to 0.8 m/s), and full community ambulation (Ͼ0.8 m/s). The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinically meaningful changes in stroke-related function and quality of life. Methods-In subacute stroke survivors with mild to moderate deficits who participated in a randomized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less, we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale (SIS). Results-Of 64 eligible participants, 19 were initially household ambulators, and 12 of them (68%) transitioned to limited community ambulation, whereas of 45 initially limited community ambulators, 17 (38%) became full community ambulators. Function and quality-of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not. Among household ambulators, those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility (Pϭ0.0299) and participation (Pϭ0.0277). Among limited community ambulators, those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation (Pϭ0.0085). Conclusions-A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life, especially for household ambulators. Household ambulators possibly had more severe stroke deficits, reducing the risk of "ceiling" effects in SIS-measured activities of daily living and instrumental activities of daily living. Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit. Outcomes should be selected that are clinically meaningful for all levels of severity.

A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors

“…Using the walking speed thresholds to described functional walking ability [22], 20 participants were not functional walkers in everyday life (speed <0.4 ms), 18 were mobile indoors (walking speed 0.4-0.6 m/s) and six were limited outdoor walkers (speed = 0.6-0.8 m/s). Twenty-two participants scored less than 45 on the BBS, which is a proposed threshold of increased falls risk post-stroke [30].…”

“…Community dwelling adult stroke survivors were identified either at discharge from inpatient stroke services or at referral to community and outpatient services at six hospitals across the West-Midlands in the UK. Participants were included if they: 1) had a gait impairment (speed <0.8m/s corresponding with limited community ambulation ability [22] and residual lower limb paresis (Fugl-Meyer [23] lower limb score <34) due to their stroke (premorbid (retrospective) modified Rankin Scale [24] score >3)…”

“…Therefore, we sought to explore the relationship between adaptability, as measured by our target stepping paradigm, and established clinical measures of motor recovery (Fugl-Meyer lower limb assessment (FM) [23] balance (Berg Balance Scale (BBS) [28] as well as overall walking competence (self-selected walking speed (SWWS) [22] (using GaitRite)). All measures were taken at baseline (i.e.…”

The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation

“…26 Gait speed is an objective measure that is sensitive to change over time, 27 and has been used as a key indicator of community ambulation among stroke survivors. 28,29 Assessment of gait was performed using the GAITRite walkway system (CIR Systems Inc., Clifton, New Jersey, USA), which is a four-metre long pressure-sensitive mat that records the placement and timing of each footfall. Participants started walking at least one metre away from the mat and walked across the mat until they reached at least one metre from the end of the mat to account for acceleration and deceleration.…”

Physical Activity Correlates with Arterial Stiffness in Community-dwelling Individuals with Stroke

“…Gait speed is associated with home and community walking activity 29 and participation. 30 Balance Ability-The Berg Balance Scale (BBS) is the most commonly used clinical measure of functional balance. It is evaluated by performing tasks, such as standing with eyes closed, turning and looking, and stepping up and down on a step.…”