Improving spatiotemporal gait parameters in spastic diplegic children using treadmill gait training

BackgroundEven though several physiotherapy techniques help to improve the spatiotemporal gait parameters of diplegic children, the efficacy of treadmill gait training together with conventional treatment techniques on spatiotemporal parameter improvement needs more investigation.ObjectiveThis study's main purpose is to investigate the effect of treadmill gait training as an adjunct to conventional physiotherapy treatment on the spatiotemporal gait parameters of diplegic children.MethodsTwenty diplegic children were distributed randomly into two equal groups (a control group of ten children who received a traditional treatment and an experimental group of ten children who received the traditional treatment together with treadmill gait training). Gait data were collected using a Vicon three-dimensional motion analysis system during regular walking.ResultsWalking speed, cadence, step length, stride length, and single limb support were enhanced in both groups (p < 0.05). Cadence and walking speed increased by 6.5 steps/min and 0.2 m/sec respectively in the experimental group, compared to the control group. Also, step length, stride length and single limb support time increased by 0.13 m, 0.27 m, and 0.07 s respectively in the experimental group, compared to the control group.ConclusionThe use of treadmill gait training together with conventional physical therapy treatment enhances the walking performance of diplegic children by improving several spatiotemporal gait parameters. Furthermore, walking balance is improved by increasing the single-leg support time.     

A comparison of the effects of visual deprivation and regular body weight support treadmill training on improving over-ground walking of stroke patients: a multiple baseline single subject design

Abstract

The body-weight-support treadmill (BWST) is commonly used for gait rehabilitation, but other forms of BWST are in development, such as visual-deprivation BWST (VDBWST). In this study, we compare the effect of VDBWST training and conventional BWST training on spatiotemporal gait parameters for three individuals who had hemiparetic strokes. We used a single-subject experimental design, alternating multiple baselines across the individuals. We recruited three individuals with hemiparesis from stroke; two on the left side and one on the right. For the main outcome measures we assessed spatiotemporal gait parameters using GAITRite, including: gait velocity; cadence; step time of the affected side (STA); step time of the non-affected side (STN); step length of the affected side (SLA); step length of the non-affected side (SLN); step-time asymmetry (ST-asymmetry); and step-length asymmetry (SL-asymmetry). Gait velocity, cadence, SLA, and SLN increased from baseline after both interventions, but STA, ST-asymmetry, and SL-asymmetry decreased from the baseline after the interventions. The VDBWST was significantly more effective than the BWST for increasing gait velocity and cadence and for decreasing ST-asymmetry. VDBWST is more effective than BWST for improving gait performance during the rehabilitation for ground walking.     

The effects of isometric trunk exercises and dynamic trunk exercises on gait in elderly people

The purpose of this study was to compare the effects of dynamic trunk exercises and isometric trunk exercises on gait in elderly people. [Subjects] This study randomly allocated 20 elderly people to an isometric trunk exercise group (n=10) and a dynamic trunk exercise group (n=10). The exercises were performed for 30 minutes three times a week for 12 weeks. Gait speed, stride length, cadence, and step width were measured at a normal pace using GAITRite. All groups were evaluated before and after 12 weeks. [Results] The isometric exercise group showed a significant change in gait velocity, cadence, and left and right step lengths. The dynamic trunk exercise group showed a significant change in gait velocity, cadence, left and right step lengths, left and right step times, and left and right stride lengths. Moreover, a comparison of the exercise effect between the two groups showed a significant difference in gait velocity. [Conclusion] The results of this study suggest that isometric trunk exercises and dynamic trunk exercises have a positive effect on gait function in elderly people. In particular, isometric trunk exercises are recommended to promote gait velocity.Key words: Isometric trunk exercise, Dynamic trunk exercise, Gait     

Effects of selected assistive devices on normal distance gait characteristics

The purpose of this study was to investigate the effects of selected assistive devices on normal standards of gait. The gait characteristics of stride length, step length, step width, and foot angle were analyzed for 24 right-dominant, healthy men under four conditions: right ankle-foot orthosis (AFO), right hemiplegic arm sling (HAS), both devices (AFO+HAS), and no devices. The dependent variables were measured by a standard method from ink traces left by subjects walking on newsprint. Order of conditions was controlled, and cadence remained consistent across all four conditions for each subject. The AFO and AFO+HAS conditions produced statistically significant changes from normal gait characteristics. The HAS alone did not produce significant changes. Data from the study may be used as a basis for goal setting and as a guideline for the optimal level of function possible for a person wearing these devices. The extent of the patient's orthopedic and neurologic involvement should of course be considered.     

A novel walking speed estimation scheme and its application to treadmill control for gait rehabilitation

ABSTRACT: BACKGROUND: Virtual reality (VR) technology along with treadmill training (TT) can effectively provide goal-oriented practice and promote improved motor learning in patients with neurological disorders. Moreover, the VR + TT scheme may enhance cognitive engagement for more effective gait rehabilitation and greater transfer to over ground walking. For this purpose, we developed an individualized treadmill controller with a novel speed estimation scheme using swing foot velocity, which can enable user-driven treadmill walking (UDW) to more closely simulate over ground walking (OGW) during treadmill training. OGW involves a cyclic acceleration-deceleration profile of pelvic velocity that contrasts with typical treadmill-driven walking (TDW), which constrains a person to walk at a preset constant speed. In this study, we investigated the effects of the proposed speed adaptation controller by analyzing the gait kinematics of UDW and TDW, which were compared to those of OGW at three pre-determined velocities. METHODS: Ten healthy subjects were asked to walk in each mode (TDW, UDW, and OGW) at three pre-determined speeds (0.5 m/s, 1.0 m/s, and 1.5 m/s) with real time feedback provided through visual displays. Temporal-spatial gait data and 3D pelvic kinematics were analyzed and comparisons were made between UDW on a treadmill, TDW, and OGW. RESULTS: The observed step length, cadence, and walk ratio defined as the ratio of stride length to cadence were not significantly different between UDW and TDW. Additionally, the average magnitude of pelvic acceleration peak values along the anterior-posterior direction for each step and the associated standard deviations (variability) were not significantly different between the two modalities. The differences between OGW and UDW and TDW were mainly in swing time and cadence, as have been reported previously (Lee and Hidler, and Wass et. al.). Also, step lengths between OGW and TDW were different for 0.5 m/s and 1.5 m/s gait velocities, and walk ratio between OGS and UDW was different for 1.0 m/s gait velocities. CONCLUSIONS: Our treadmill control scheme implements similar gait biomechanics of TDW, which has been used for repetitive gait training in a small and constrained space as well as controlled and safe environments. These results reveal that users can walk as stably during UDW as TDW and employ similar strategies to maintain walking speed in both UDW and TDW. Furthermore, since UDW can allow a user to actively participate in the virtual reality (VR) applications with variable walking velocity, it can induce more cognitive activities during the training with VR, which may enhance motor learning effects.     

Treadmill training for ataxic patients: a single-subject experimental design

OBJECTIVE: To investigate changes in gait quality, balance and mobility associated with treadmill training for ataxic individuals. DESIGN: Single-subject ABA design. Baseline phases (A) lasted three weeks and intervention (B) lasted four weeks. SETTING: University rehabilitation clinic. SUBJECTS: A woman (25 years) and a man (53 years) with chronic ataxia due to head trauma. INTERVENTION: Three 20-minute treadmill training sessions each week with progression in velocity and step length. MAIN MEASURES: Rivermead Visual Gait Assessment, Timed Up and Go, time to complete a balance task, walking speed, cadence, and stride length assessments three times a week during the 10 weeks. Data were analysed with the celeration line technique and two standard deviation band. RESULTS: Both individuals demonstrated gains in all parameters over initial baseline and subsequent phases, with performance increases ranging from 26% to 233% when first and last assessments were compared. Significantly superior effects of treadmill training over baseline conditions on cadence were detected (P<0.05). Gains in walking speed were not significantly better during intervention, but intervention withdrawal produced deceleration of performance gains. Gains in Timed Up and Go, step length and balance were not consistent and were possibly caused by a learning effect of the association between repeated testing and treadmill training. Rivermead Visual Gait Assessment gains reached significance only for subject 2 (P<0.05), probably because of increased variability of performance of subject 1. Results suggest that the association between repeated testing and treadmill training might have been responsible for the observed gains in the two ataxic patients.     

Effect of the Modulation of Optic Flow Speed on Gait Parameters in Children with Hemiplegic Cerebral Palsy

[Purpose] We investigated the effects of modulation of the optic flow speed on gait parameters in children with hemiplegic cerebral palsy. [Methods] We examined 10 children with hemiplegic cerebral palsy. The children underwent gait analysis under 3 different conditions of optic flow speed: slow, normal, and fast optic flow speed. The children walked across the walkway of a GAITRite system, while watching a virtual reality screen, and walking velocity, cadence, stride length, step length, single support time, and double support time were recorded. [Results] Compared with the other applied flow speed conditions, the fast optic flow speed (2 times the normal speed) significantly increased walking velocity, cadence, normalized step length, base of support, and single support cycle of both the paretic and non-paretic lower limbs. Moreover, compared with the other applied flow speed conditions, the slow optic flow speed (0.25 times the normal speed) yielded a significantly decreased walking velocity, cadence, normalized step length, base of support, and single support cycle for both the paretic and non-paretic lower limbs. [Conclusion] The gait parameters of children with hemiplegic cerebral palsy are altered by modulation of the optic flow speed. Thus, we believe that gait training involving modulation of the optic flow speed is feasible and suitable for resolving abnormal gait patterns in children with hemiplegic cerebral palsy.Key words: Optic flow, Gait parameter, Hemiplegic cerebral palsy     

Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report

The effects of task-repetitive locomotor training on stroke patients' spatial and temporal gait parameters during unassisted walking are not well understood. This study determined the effects of treadmill aerobic exercise (T-EX) on spatial and temporal gait parameters that underlie changes in overground walking function. Thirty-nine subjects with hemiparetic stroke underwent T-EX three times weekly for 6 months. We measured the subjects pre- and posttraining on 30-foot timed walks and 6-minute distance walks with usual assistive devices and on an 8 m instrumented walkway without assistive devices. T-EX improved 30-foot walks by 17% and 6-minute walks by 23%. Unassisted walking velocity increased 22%, stride length increased 13%, and cadence increased 7%. Paretic and nonparetic step lengths increased significantly, and respective step times decreased significantly. Interlimb symmetry did not change. This study presents preliminary evidence that changes in spatial and temporal gait parameters contribute to the increased velocity of subjects with stroke after T-EX.     

The Effects of Augmented Reality-based Otago Exercise on Balance,Gait, and Falls Efficacy of Elderly Women

[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.Key words: Augmented reality, Otago exercise, Falls efficacy     

A three-dimensional kinematic and kinetic comparison of overground and treadmill walking in healthy elderly subjects

Background

Instrumented treadmills offer a number of advantages for the biomechanical analysis of elderly gait, yet it is unclear how closely treadmill gait approximates overground gait. Although studies have indicated that the kinematics and kinetics of overground and treadmill gait are very similar in young adults, it still needs to be determined whether data collected in elderly adults during treadmill walking can be generalized to overground gait. The purpose of this study, therefore, was to compare the three-dimensional kinematics and kinetics of treadmill gait to overground gait in a group of healthy elderly subjects.

Methods

Three-dimensional kinematic and kinetic data for 18 healthy, nondisabled elderly subjects, age 65–81 years, were collected for speed-matched overground and treadmill walking conditions.

Findings

Overall, the kinematics and kinetics of gait during treadmill and overground walking in the elderly had very similar patterns. However, during treadmill walking elderly subjects showed greater cadence, smaller stride length and stride time as well as reductions in the majority of joint angles, moments and powers when compared to overground walking.

Interpretation

The large increase in cadence suggests that an effective method of acclimation to treadmill walking still needs to be determined. Because of the differences, we believe that in order for instrumented treadmills to become a suitable tool for research and training purposes in healthy elderly, subjects must be adequately acclimated to the treadmill.     

Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study

OBJECTIVE: To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI). DESIGN: Before-after crossover trial with control (A) and intervention (B) periods. SETTING: Physiotherapy (PT) department of a spinal injuries unit in Scotland. PARTICIPANTS: Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury. INTERVENTION: Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given. MAIN OUTCOME MEASURES: Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill. RESULTS: A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; CI, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; CI, 1.8-75.0m; BA group mean, 60.1m; CI, 9.2-110.9m). A similar pattern was observed for overground walking speed. CONCLUSIONS: This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings.     

认知负荷任务对帕金森病患者步态的干扰效应

目的:探讨认知负荷任务对帕金森病患者步态的影响。方法:8例帕金森病患者和6例健康对照受试者参与本研究。要求受试者完成以下2种条件下的步行:一是以自己感觉最舒适的速度自由步行2min;二是步行的同时执行一个计算任务。采用三维运动分析仪记录2种条件下的步态参数。此外,要求两组受试者在安静坐位条件下完成2min的计算任务,记录2种条件下的计算完成数和错误率。结果:自由步行条件下,帕金森病组的步幅、步长和步速低于对照组。计算负荷条件下,帕金森病组的步长、步幅、步速、步频、摆动相和单支撑相均显著减低,双支撑相和总支撑相时间显著延长。在加载计算任务后,帕金森病组的步速和步幅变异较其自由步行时显著增加,且步幅变异亦明显高于对照组。帕金森病组安静坐位时计算完成数显著低于对照组,在步行的同时加载计算任务后其计算完成数显著高于对照组。结论:健康老年人的步态对认知调控的依赖程度不高,帕金森病患者的步态明显受认知负荷的干扰,并存在认知资源配置的不合理。     

The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study

The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke. Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups. In addition to conventional physical therapy, the experimental group participated in 15 treadmill-training sessions in which a handrail was used for external support. The control group received the same number of equal length sessions of over-ground ambulation. Treatment effects were established by pre- and posttreatment assessment of: 1) functional walking ability, 2) walking speed, 3) stride length, 4) temporal characteristics of gait, and 5) electromyographic activity of calf muscles. Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors. The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus. Furthermore, the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation, stride length, percentage of paretic single stance period, and gastrocnemius muscular activity.     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周后使用三维步态分析仪器检测并获得两组患者的步态参数。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。     

Effects of Dual Task Training on Dual Task Gait Performance and Cognitive Function in Individuals With Parkinson Disease: A Meta-analysis and Meta-regression

ObjectiveTo explore the effects of dual task (DT) training on DT gait performance and cognitive function in individuals with Parkinson disease (PD) and to examine factors that might influence the effects of DT training.Data SourcesPubMed, Wiley Online Library, Cochrane Library, CINAHL, and Medline were searched for articles published from January 2006 to December 2021.Study SelectionRandomized controlled trials comparing DT training with usual care or general exercise were included.Data ExtractionThe outcomes studied were DT gait parameters including speed, step and stride length, cadence, step and stride time variability, dual-task cost on gait speed, and Trail Making Tests presented as standardized mean differences (SMDs). The Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate the quality of evidence.Data SynthesisTen randomized controlled trials with 466 participants were included in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. Meta-analyses used a random-effects model for all analyses. The meta-analysis showed the DT training effects on DT gait speed (SMD=0.825, P=.012), DT step and stride length (SMD=0.400, P=.015), Trail Making Tests-part A (TMT-A; SMD=0.533, P=.010), and Trail Making Tests-part B (SMD=0.516, P=.012) compared with the control group. Only the effect on TMT-A was maintained at the follow-up assessment. The results of meta-regression showed that participants with slower initial single task gait speed improved more after DT training on DT step and stride length.ConclusionsThe DT training improved more in DT gait speed with moderate-quality evidence as compared with usual care or conventional physical training in individuals with PD. The beneficial effects of DT training on DT step and stride length, attention, and executive function were also demonstrated in this meta-analysis. Furthermore, the improvement in the DT walking step and stride length was related to the participant's initial single task gait speed.     

A clinical trial of strengthening and aerobic exercise to improve gait and balance in elderly male nursing home residents.

The purpose of this study was to determine whether a moderate to high intensity strengthening and aerobic exercise program can improve the strength, exercise capacity, gait and balance of deconditioned male nursing home residents. Ambulatory subjects who scored 30 or less on the modified Tinetti gait and balance assessment scale, who demonstrated less than 80% of age-matched lower extremity strength on isokinetic muscle testing and who gave informed consent were enrolled. Subjects were randomized to either an exercise (n = 8) or a control (n = 6) group. All participants underwent an exercise test to determine maximal oxygen uptake (VO2max) and received quantitative gait and balance measurements. The subjects assigned to the exercise group than completed a 12-wk program of weight training for the lower extremities and stationary cycling. Both the exercise and control groups were then retested. Ten outcome variables were assessed: Tinetti mobility scores, VO2max, isokinetic-tested lower extremity strength and endurance, stride length, gait velocity, stance time, gait duration, cadence and balance. The exercise group, after completion of the program, demonstrated significant improvements in Tinetti mobility scores (P < 0.05), combined right and left quadricep muscle strength (P < 0.01), right and left lower extremity muscular endurance (P < 0.01), left stride length and gait velocity (P < 0.05), although other outcome variables changed insignificantly. The control group revealed no changes of significance with the exception of improvement of the combined right and left hamstring muscle strength (P < 0.05). Nevertheless, for those outcome variables that had improved significantly in the exercise group, the changes amounted to only a 5 to 10% increase over the baseline measurements. These findings showed that an appropriately designed high intensity exercise program can result in significant although limited improvements for clinical mobility scores, strength, muscular endurance and certain gait parameters.     

Effects of gait training with horizontal impeding force on gait and balance of stroke patients

[Purpose] The purpose of this study was to investigate the effects of treadmill training with a horizontal impeding force applied to the center of upper body mass on the gait and balance of post-stroke patients. [Subjects and Methods] Twenty-four subjects with hemiplegia less than 3 months after stroke onset were randomly assigned to 2 groups: an applied horizontal impeding force on treadmill training (experimental) group (n = 12), and a control group (n = 12). Both groups walked on a treadmill at a comfortable or moderate speed for 20 minutes per day, 3 sessions per week for 8 weeks after a pre-test. The experimental group also had a horizontal impeding force applied to the center of their upper body mass. [Results] All groups demonstrated significant improvement after 8 weeks compared to baseline measurements. In intra-group comparisons, the subjects’ gait ability (CGS, MGS, cadence, and step length) and balance ability (TUG, BBS, and FRT) significantly improved. In inter-group comparisons, the experimental group’s improvement was significantly better in CGS MGS, cadence, step length, TUG, and BBS, but not in FRT. [Conclusion] Treadmill training was identified as an effective training method that improved gait and balance ability. A horizontal impeding force applied during treadmill training was more effective than treadmill walking training alone at improving the gait and dynamic balance of patients with stroke.Key words: Treadmill gait, Horizontal impeding force, Upper body     

Immediate effects of an elastic arm sling on walking patterns of chronic stroke patients

[Purpose] We developed a new arm sling with an elastic bandage which we hearafter refer to as “the elastic arm sling”. This study investigated the immediate effects of the elastic arm sling on the gait patterns of stroke patients. [Subjects and Methods] Thirteen stroke patients were enrolled in this study after providing their informed consent. They walked on a GAITRite mat twice, with a 5-min rest between the trials. [Results] Significant improvements were seen in cadence and walking velocity during walking while wearing the elastic arm sling. Furthermore, patients who used the elastic arm sling showed significant increases in step lengths of the affected and unaffected limbs. The stride lengths of the affected and unaffected sides while wearing the elastic arm sling and those without the elastic arm sling also significantly differed. [Conclusion] These results demonstrate that the elastic arm sling is a useful tool for the gait training of stroke patients, especially cadence, walking velocity, and the step and stride lengths of both limbs. Therefore, therapists should use the elastic arm sling as a gait-training assistive device for stroke patients.Key words: Elastic arm sling, Hemiplegic gait, Orthotic devices     

Effect of intrathecal baclofen bolus injection on temporospatial gait characteristics in patients with acquired brain injury

OBJECTIVE: To evaluate changes in temporospatial gait parameters after intrathecal baclofen (ITB) bolus administration in patients with spasticity resulting from acquired brain injury by using computerized gait analysis. DESIGN: Case series; before-after intervention. Walking performance and spasticity in lower-extremity muscles were assessed before and at 2, 4, and 6 hours after ITB bolus injection. SETTING: Tertiary care free-standing rehabilitation hospital. PARTICIPANTS: Consecutive sample of 28 adults with acquired brain injury due to stroke, trauma, or anoxia. INTERVENTION: A 50-microg ITB bolus injection (2 subjects received 75 microg and 100 microg, respectively). MAIN OUTCOME MEASURES: Ashworth Scale scores, self-selected gait velocity, stride length, cadence, step length symmetry, step width, and percentage of single support on the more involved side. RESULTS: Ashworth score decreased from 2.0+/-0.5 at baseline to 1.3+/-0.3 at peak response ( P <.001), whereas gait velocity increased from 41+/-26 to 47+/-31 cm/s ( P <.001). Significant improvements also occurred in stride length ( P <.05) and step width ( P <.001). Gait velocity was the most sensitive temporospatial outcome measure for differentiating functional response to ITB bolus injection. Sixteen patients increased velocity by an average of 12 cm/s, representing a mean gain of 33% over their baseline walking speed, while 5 decreased (mean loss, -6 cm/s [52% of baseline]) and 7 were unchanged. There was a significant correlation between baseline velocity and peak change in velocity after ITB bolus ( r =.39, P <.05). Baseline Ashworth score correlated inversely with velocity, stride length, cadence, and percentage single support (r range, -.46 to -.57). No significant correlations were found between change in Ashworth score and change in any temporospatial outcome measure. CONCLUSIONS: ITB bolus injection consistently reduces spasticity in ambulatory patients with acquired brain injury but may result in a range of changes in walking performance that can be reliably detected using computerized motion analysis. Velocity appears to be the most sensitive parameter with which to classify individual patient response. The relation between baseline gait velocity and peak change in velocity after bolus administration may have application in predicting the outcome of screening trials for pump implantation; it warrants further investigation.