Article
Deficit and change in gait velocity during rehabilitation after stroke

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Abstract

Objective: To quantify the initial deficit, change, and outcome in gait velocity during inpatient rehabilitation following stroke.

Design: The initial deficit on admission to rehabilitation was quantified by comparing 42 stroke patients with 42 controls matched by gender and age. The change in the stroke patients during the next 8 weeks was quantified and gait outcome was compared with functional and normal criteria.

Setting: Patients were referred from four inpatient rehabilitation centers at the time of admission following a median of 16.5 days in the acute hospital.

Patients: Selection criteria: ability to give informed consent; unilateral first stroke; ability to walk 10 meters.

Intervention: Patients participated in a median of 17.38 hours of individual physical therapy including a median of 6.92 hours of gait training during the 8 weeks.

Main Outcome Measure: Gait velocity.

Results: Gait velocity was initially 38.6% (26.7m/min SD = 14.9) of the performance of controls and improved to 55.1% (38.1m/min). At outcome only 24% exceeded the 5th percentile of controls (48.1m/min) or the velocity required to cross the typical signalled intersection (46.2m/min). The change was only 26% of the initial deficit. Fifty-five percent of the patients improved beyond the 95% confidence intervals surrounding the error of measuring change. Indices of responsiveness indicated that there was a high signal-to-noise ratio and a robust effect size.

Conclusion: Gait velocity discriminated the effect of stroke and the change during rehabilitation.

References (49)

  • ML Dombovy

    Rehabilitation and the course of recovery after stroke

  • PW Duncan

    Stroke disability

    Phys Ther

    (1994)
  • PJ Friedman

    Gait recovery after hemiplegic stroke

    Int Disabil Studies

    (1990)
  • DT Wade et al.

    Functional abilities after stroke: measurement, natural history and prognosis

    J Neurol Neurosurg Psychiatry

    (1987)
  • RW Bohannon et al.

    Importance of four variables of walking to patients with stroke

    Int J Rehabil Res

    (1991)
  • CM Mumma

    Perceived losses following stroke

    Rehabil Nurs

    (1986)
  • HS Jorgensen et al.

    Recovery of walking function in stroke patients: The Copenhagen Stroke Study

    Arch Phys Med Rehabil

    (1995)
  • CL Richards et al.

    The relationship of gait speed to clinical measures of function and muscle activations during recovery post-stroke

  • PJ Friedman et al.

    A prospective trial of serial gait speed as a measure of rehabilitation in the elderly

    Age Ageing

    (1988)
  • CL Richards et al.

    Gait velocity as an outcome measure of locomotor recovery after stroke

  • DT Wade et al.

    Walking after stroke

    Scand J Rehabil Med

    (1987)
  • DT Wade

    Measurement in neurological rehabilitation

    (1992)
  • KD Hill et al.

    Retest reliability of the temporal and distance characteristics of hemiplegic gait using a footswitch system

    Arch Phys Med Rehabil

    (1994)
  • ME Brandstater et al.

    Hemiplegic gait: analysis of temporal variables

    Arch Phys Med Rehabil

    (1983)
  • SJ Olney et al.

    Work and power in gait of stroke patients

    Arch Phys Med Rehabil

    (1991)
  • MV Johnston et al.

    Measurement standards for interdisciplinary medical rehabilitation

    Arch Phys Med Rehabil

    (1992)
  • DE Krebs

    Interpretation standards in locomotor studies

  • A Shumway-Cook et al.

    Motor control: theory and practical applications

    (1995)
  • J Mizrahi et al.

    Objective expression of gait improvement of hemiplegics during rehabilitation by time-distance parameters of the stride

    Med Biol Eng Comput

    (1982)
  • R Nakamura et al.

    Computer-assisted gait training (CAGT) of hemiparetic stroke patients: Whose recovery is most predictable?

    Tohoku J Exp Med

    (1992)
  • CJ Winstein et al.

    Standing balance trainingL Effect on balance and locomotion in hemiparetic adults

    Arch Phys Med Rehabil

    (1989)
  • RC Wagenaar et al.

    The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method

    Scand J Rehabil Med

    (1990)
  • CL Richards et al.

    Task-specific physical therapy for optimization of gait recovery in acute stroke patients

    Arch Phys Med Rehabil

    (1993)
  • Shah SK, Bain C. Admissions, patterns of utilization and disposition of cases of acute stroke in Brisbane hospitals....
  • Cited by (0)

    Supported by a Commonwealth (Australian) Health Services Research and Development Grant.

    No commercial party having a direct or indirect interest in the subject matter of this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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