Measurement of Community Ambulation After Stroke

Abstract

Background and Purpose-This report considers the measurement of community ambulation for people with stroke. The conceptual issues underlying measurement of community ambulation are reviewed, and tests that measure either the task itself or at least some of its components are identified and discussed. Conclusions-The findings from this review suggest that although some progress has been made toward identifying community ambulation as a stand-alone entity, reliable and valid measures have not yet been developed. Gait speed, which is used often as a proxy measure for community ambulation, does not consistently reflect the level of community ambulation attained, and continued reliance on its use, particularly the 10-m timed walk, is misplaced. The limitations of the measures reviewed here point toward self-report as being the most useful outcome for current clinical use. However, this report highlights the need for research to first inform a theoretical framework for the measurement of community ambulation, from which a measurement tool or a battery of measurements can be developed and tested.

Community Walking Training Program Improves Walking Function and Social Participation in Chronic Stroke Patients

“…Previous studies have emphasized that distances of 150 to 300 m, obstacles, and an uneven surface are prerequisites for constructing a community ambulation training program (Hill et al 1997;Shumway-Cook et al 2003). However, most stroke rehabilitation programs for improving walking function are conducted in clinical or hospital settings; it cannot be assumed that these settings will suffice for providing outdoor environmental situations (Lord and Rochester 2005). Thus, this study conducted a CWTP with stroke patients consisting of a real community environment, and we observed significant improvements in walking function.…”

“…Thus, current study evaluated social participation after four weeks of a CWTP, and significant improvement in social participation was observed in the CWTP group compared to the control group. Independent walking ability is an essential factor for reincorporation of stroke patients into community life (Lord and Rochester 2005;Salter et al 2007). The current CWTP, which consisted of a real community environment, may motivate subjects to actively participate in training program, thereby increasing walking function and confidence in community participation.…”

“…Community walking is defined as a complicated and challenging activity requiring the ability to walk at a given speed for a minimum requisite distance and to adapt to changes in various environments (Shumway-Cook et al 2002). For successful reintegration into community life after stroke, walking training within a real community environment is needed, as well as indoor walking training that is predictable and simple (Lord and Rochester 2005). A recent advance is recognition that successful stroke rehabilitation is determined by the degree of social participation after hospital discharge (Hamzat and Kobiri 2008).…”

Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury

“…This test has been used in gait studies of patients with neurological diseases. 11 6 MWT measures the distance (in meters) walked within 6 min. This test is useful in assessing cardiovascular exercise capacity in elderly patients with congestive heart failure or chronic lung disease and walking ability in patients with acquired brain injury.…”

“…5 Two of the most important factors in achieving community ambulation are gait velocity and endurance. 6,7 Gait speed is often measured in a clinic setting but it is unknown whether clinic-measured gait speed can predict community performance on individuals with SCI. 8,9 To the best of our knowledge there are no publications focusing on the impact of the environment on gait performance of SCI patients.…”