Predicting Improvement in Gait After Stroke

Abstract

Background and Purpose-To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability. Methods-A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population. Prospective cohort study based on 18 repeated measurements over time during the first poststroke year. Baseline characteristics as well as longitudinal information from functional ambulation categories (FAC), Fugl-Meyer leg score (FM-leg), Motricity index leg score (MI-leg), letter cancellation task (LCT), Fugl-Meyer balance (FMbalance), and timed balance test (TBT) were obtained. Intervention consisted of a basic rehabilitation program with additional arm, leg, or air splint therapy. Main outcome measure constituted change scores on FAC over time. Results-In total, 1532 of the 1717 change scores were available for regression analysis. The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC (␤ϭ0.094; PϽ0.001) followed by changes scores on FM-leg (␤ϭ0.014; PϽ0.001) and reduction in LCT omissions (␤ϭϪ0.010; PϽ0.001) and MI leg test (␤ϭ0.001; PϽ0.001). In addition, time itself was significantly negatively associated with improvement (␤ϭϪ0.002; PϽ0.001). Conclusion-Improvement in standing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability, whereas reduction in visuospatial inattention is independently related to improvement of gait. Finally, time itself is an independent covariate that is negatively associated with change on FAC, suggesting that most pronounced improvements occur earlier after stroke.

Study of the Recovery Patterns of Elderly Subacute Stroke Patients in an Interdisciplinary Neurorehabilitation Unit

“…Of these studies, only one (4) has examined functional results at six-month intervals, taking into account assessments performed at the same times (0, 6 and 12 months) as in this study. Other researchers have frequently decided to establish intermediate assessment points, at one, two, there, four, six and 12 months (11,16,17), every months (5,10), or even every week from the commencement of rehabilitation (6,7,9).…”

“…Yet it has still been possible to discuss our results with reference to those elsewhere in the literature as the improvement percentages attributed to the different periods are also provided in terms of the commonly used assessment scales. Most of the studies cited use a scale for the assessment of the ADL -the Barthel index (4-7,11), -although some have employed motor indices such as the Functional Ambulation Category, Fugl-Meyer Assessment or the Motricity Index (5,9) or neurological scales such as the Scandinavian Stroke Scale (6).…”

“…Although a great deal is known about the neurophysiological mechanisms responsible for recovery from neurological deficits, involving brain reorganization and the mechanism of neuroplasticity (3), a variety of functional recovery patterns have been described for patients with stroke sequelae by a range of authors (4)(5)(6)(7)(8)(9)(10)(11).…”

Generation and Content Validation of Mobility Domains and Item Pool for Community-dwelling Individuals

“…In addition to these scales, items were also extracted from certain ambulation profiles including functional ambulation categories (Kollen et al, 2005), Hauser Ambulation Index (Hauser et al, 1983) and Modified Emory Functional Ambulation Index (Baer and Wolf, 2001). The identified items were compiled and used for the next stage of item generation that included persons with mobility disability.…”

Association of Ability to Rise from Bed with Improvement of Functional Limitation and Activities of Daily Living in Hemiplegic Inpatients with Stroke: a Prospective Cohort Study

“…Similarly, sitting ability on admission could predict independent gait [8][9][10] . Improvement in standing balance is another factor that is important for achieving improvement of gait 11) . Hence, lower-limb motor evoked potentials amplitudes could be a useful prognosis tool regarding lower-limb motor outcome 12) .…”