Examination of Sustained Gait Speed During Extended Walking in Individuals With Chronic Stroke

Objectives

To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups.

Design

Prospective cross-sectional study.

Setting

University-based research laboratory, hospitals, and stroke support groups.

Participants

A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit.

Interventions

Not applicable; 1-time cross-sectional data collection.

Main Outcome Measures

During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups.

Results

During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences.

Conclusions

Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.     

Cardiorespiratory Responses to Pool Floor Walking in People Poststroke

Objective

To compare cardiorespiratory responses between pool floor walking and overground walking (OW) in people poststroke.

Functional Electrical Stimulation to Dorsiflexors and Plantar Flexors During Gait to Improve Walking in Adults With Chronic Hemiplegia

Embrey DG, Holtz SL, Alon G, Brandsma BA, McCoy SW. Functional electrical stimulation to dorsiflexors and plantar flexors during gait to improve walking in adults with chronic hemiplegia.

Objective

To determine whether functional electrical stimulation (FES) timed to activate the dorsiflexors and plantar flexors during gait improves the walking of adults with hemiplegia.

Design

Randomized crossover trial.

Setting

Outpatient rehabilitation clinic.

Participants

Adults with hemiplegia (N=28) with a mean age ± SD of 60±10.9 years and 4.9±3.8 years postincident.

Interventions

Intervention “A” included 3 months of wearing the FES system, which activated automatically during walking for 6 to 8h/d, 7d/wk, plus walking 1h/d, 6d/wk. Intervention “B” included 3 months of walking 1h/d, 6d/wk without FES. Of the 28 patients who completed the study, 15 were randomly assigned to group A-B, 13 to group B-A. Crossover occurred at 3 months.

Main Outcome Measures

Variables were measured at pretreatment, 3 months, and 6 months. Three primary outcomes were selected a priori and included 2 functional variables, the 6-minute walk test and the Emory Functional Ambulatory Profile, and 1 participation variable, the Stroke Impact Scale. Secondary impairment measures included muscle strength and spasticity. Assessments were done without electrical stimulation.

Results

In phase 1, patients who received treatment A (A-B group) showed improvement compared with patients who received treatment B (B-A group) on the 6-minute walk test (P=.02), Emory Functional Ambulatory Profile (P=.08), and Stroke Impact Scale (P=.03). In phase 2, the A-B group maintained improvement in all 3 primary outcomes even without FES. Both groups improved significantly on all primary outcome measures, comparing 6-month to initial measures (P≤.05).

Conclusions

An FES system that stimulates dorsiflexors and plantar flexors similar to the timing of typical adult gait, combined with daily walking, can improve the walking ability of adults with hemiplegia.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.     

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.

Objective

To determine whether oxygen consumption (V˙o₂) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.

Design

Exploratory case-control study.

Setting

Medical school exercise physiology laboratory.

Participants

Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).

Intervention

None.

Main Outcome Measures

V˙o₂ on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).

Results

Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.

Conclusion

V˙o₂ on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.     

The Reliability of Spatiotemporal Gait Data for Young and Older Women During Continuous Overground Walking

Paterson KL, Hill KD, Lythgo ND, Maschette W. The reliability of spatiotemporal gait data for young and older women during continuous overground walking.

Objective

To examine the reliability and systematic bias in spatiotemporal gait parameters recorded in healthy women during repeated single and continuous overground walking trials.

Design

Test-retest.

Setting

University laboratory.

Participants

Young (n=13) and older adult (n=14) women volunteers.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal data were collected from an 8.1-m GAITRite mat during 10 trials of discrete single walks and 10 laps of a continuous circuit presented in random order over 2 separate test sessions. Paired t tests, intraclass correlation coefficients (ICCs), SE of measurement, and coefficients of variation (CV) were calculated.

Results

The relative and absolute measures of reliability showed most spatiotemporal variables recorded during the single and continuous walking protocols were reliable. Step length, foot angle, and step and stance times were found to be the most reliable parameters, with ICCs ranging from 0.84 to 0.95, CVs from 2.06% to 4.02%, and SE of measurements of 1.59 to 2.04cm for step length, 1.32° to 1.71° for foot angle, and 0.011 to 0.025 seconds for step and stance times. Reliability estimates were similar for the single and continuous trial conditions and between the young and older women. Although small mean differences in the gait parameters were found across the test sessions, many of these parameters showed systematic bias (P≤.05). In the single trial condition, the majority (65%) of the gait parameters showed significant bias, whereas in the continuous condition only 19% of the parameters exhibited bias. For the young women, 54% of the parameters showed systematic bias (P≤.05) in the single trial condition, whereas 77% of the parameters exhibited bias for the older women. In the continuous walking condition, 38% of the gait parameters showed systematic bias (P≤.05) for the young women, whereas no systematic bias was found in the gait parameters of the older women.

Conclusions

This study shows that both the single and continuous walking protocols are reliable methods for the collection of gait data in young and older women. It also shows that a continuous overground walking protocol produces less bias in test-retest spatiotemporal gait data. Therefore, a continuous protocol may be a better method when attempting to monitor gait changes over time, especially for older women.     

Efficacy of Partial Body Weight-Supported Treadmill Training Compared With Overground Walking Practice for Children With Cerebral Palsy: A Randomized Controlled Trial

Willoughby KL, Dodd KJ, Shields N, Foley S. Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.

Objective

To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking.

Design

Randomized controlled trial.

Setting

Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities.

Participants

Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10y, 10mo ± 3y, 11mo [range, 5-18y]) completed training and testing.

Interventions

Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice.

Main Outcome Measures

Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment.

Results

The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment.

Conclusions

PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP.     

Effects of kinesiotaping combined with the motor relearning method on upper limb motor function in adults with hemiparesis after stroke

IntroductionKinesio Taping (KT) is being widely used in neurorehabilitation as an adjuvant technique due to its therapeutic effects. The objective of this study was to determine the effects of Kinesio Taping combined with the motor relearning method on upper limb motor function in adult patients with post-stroke hemiparesis.MethodsA quasi-experimental study with pre-test and post-test in a sample of 10 adult patients with post-stroke hemiparesis, randomly assigned in two groups: experimental (n: 5) who received 12 sessions of Kinesio Taping combined with the motor relearning method and a control group (n: 5) who only received 12 sessions of the motor relearning method. Motor function was assessed through the selective movement pattern scale for adult patients with upper motor neuron injury before and after each intervention.Resultsstatistically significant differences (p < 0.05) were found when comparing the means of upper limb movement patterns of the experimental group.Conclusionsthe use of Kinesio Taping combined with the motor relearning method was encouraging for upper limb motor function in patients with spastic hemiparesis.     

Interlimb Coordination During the Stance Phase of Gait in Subjects With Stroke

Objective

To analyze the relation between contralesional and ipsilesional limbs in subjects with stroke during step-to-step transition of walking.

Design

Observational, transversal, analytical study with a convenience sample.

Setting

Physical medicine and rehabilitation clinic.

Participants

Subjects (n=16) with poststroke hemiparesis with the ability to walk independently and healthy controls (n=22).

Interventions

Not applicable.

Main Outcome Measures

Bilateral lower limbs electromyographic activity of the soleus (SOL), gastrocnemius medialis, tibialis anterior, biceps femoris, rectus femoris, and vastus medialis (VM) muscles and the ground reaction force were analyzed during double-support and terminal stance phases of gait.

Results

The propulsive impulse of the contralesional trailing limb was negatively correlated with the braking impulse of the leading limb during double support (r=−.639, P=.01). A moderate functional relation was observed between thigh muscles (r=−.529, P=.035), and a strong and moderate dysfunctional relation was found between the plantar flexors of the ipsilesional limb and the vastus medialis of the contralesional limb, respectively (SOL-VM, r=−.80, P<.001; gastrocnemius medialis-VM, r=−.655, P=.002). Also, a functional moderate negative correlation was found between the SOL and rectus femoris muscles of the ipsilesional limb during terminal stance and between the SOL (r=−.506, P=.046) and VM (r=−.518, P=.04) muscles of the contralesional limb during loading response, respectively. The trailing limb relative impulse contribution of the contralesional limb was lower than the ipsilesional limb of subjects with stroke (P=.02) and lower than the relative impulse contribution of the healthy limb (P=.008) during double support.

Conclusions

The findings obtained suggest that the lower performance of the contralesional limb in forward propulsion during gait is related not only to contralateral supraspinal damage but also to a dysfunctional influence of the ipsilesional limb.     

The Effects of Foot Position on the Performance of the Sit-To-Stand Movement With Chronic Stroke Subjects

Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.

Objective

To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.

Design

Cross-sectional.

Setting

Research laboratory.

Participants

Twelve chronic stroke subjects (N=12).

Interventions

Not applicable.

Main Outcome Measures

Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.

Results

Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.

Conclusions

The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study.     

Effect of Balance Support on the Energy Cost of Walking After Stroke

Objective

To examine the influence of balance support on the energy cost of treadmill and overground walking in ambulatory patients with stroke.

Design

Cross-sectional.

Setting

Research laboratory at a rehabilitation center.

Participants

Patients with stroke depending on a walking aid in daily life (n=12; walking aid dependent ambulators) and walking aid independent ambulators (n=12), all able to walk for at least 5 minutes.

Interventions

Not applicable.

Main Outcome Measures

Energy cost (J·kg⁻¹·m⁻¹) and temporal gait parameters (walking speed, mean and coefficient of variation of stride time, and symmetry index) were obtained during 4 walking trials at preferred walking speed: overground with and without a cane and on a treadmill with and without handrail support.

Results

On the treadmill, handrail support resulted in a significant decrease in energy cost of 16%, independent of the group. Although walking aid dependent ambulators had on average a larger reduction in energy cost than walking aid independent ambulators (19% vs 14%), this interaction did not reach statistical significance (P=.11). Interestingly, overground walking with support resulted in an 8% reduction in energy cost for walking aid dependent ambulators, but a 6% increase for walking aid independent ambulators. The reduction in energy cost with support was accompanied by changes in temporal gait parameters, most notably an increase in stride time and symmetry and a decrease in stride time variability.

Conclusions

Balance support can result in a significant reduction in the energy cost of walking in stroke patients, the magnitude of which depends on walking ability and the walking task. Impaired balance control should not be overlooked as a contributing factor to the increased energy cost of walking in patients with stroke, and improving or assisting balance control should be considered to reduce the energy cost of hemiplegic gait.     

The Associations Between the Dominant and Nondominant Peak External Knee Adductor Moments During Gait in Healthy Subjects: Evidence for Symmetry

Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The associations between the dominant and nondominant peak external knee adductor moments during gait in healthy subjects: evidence for symmetry.

Objectives

There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults.

Design

Cross-sectional study.

Setting

Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia.

Participants

Three-dimensional Vicon gait analyses were performed for 17 healthy men and women.

Interventions

Not applicable.

Main Outcome Measures

The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs.

Results

Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively.

Conclusions

In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally.     

Interventions to Promote Long-Term Participation in Physical Activity After Stroke: A Systematic Review of the Literature

Objective

To investigate the effects of interventions to promote long-term participation in physical activity (PA) on measures of frequency, duration, or intensity of PA at 3 months or longer in community-dwelling stroke survivors.

Data Sources

MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and Cochrane Library of Systematic Reviews between 1987 and December 2012. Search terms included “physical activity, exercise promotion,” “stroke,” “behavior change interventions,” and their synonyms.

Study Selection

Randomized controlled trials or comparison studies involving stroke survivors, with follow-up of ≥3 months, examining interventions to increase long-term participation in PA.

Data Extraction

Preferred reporting items for systematic reviews and meta-analyses guidelines informed data extraction. Risk of bias was assessed using the Cochrane Collaboration tool. Two reviewers independently reviewed abstracts and extracted data.

Data Synthesis

Of 2888 studies, 11 involving 1704 participants were included. Risk of bias occurred in randomization methods and blinding. Limited data and study heterogeneity meant that data pooling was not possible. Odds ratios and continuous data as weighted mean differences, however, were calculated using fixed-effect models and 95% confidence intervals. Two intervention types were identified: individualized tailored counseling with or without supervised exercise (n=6 studies) and supervised exercise with advice (n=5 studies). Three studies illustrated increased odds of meeting recommended PA levels and participation in PA at 12 months after tailored counseling (P<.05). Two studies showed improved step count at 3 months with supervised exercise only (P<.05); however, PA levels had declined by 3 months. Tailored home exercise was the only predominantly exercise-based intervention to demonstrate higher PA participation at 12 months.

Conclusions

This study provides some evidence that tailored counseling alone or with tailored supervised exercise improves long-term PA participation and functional exercise capacity after stroke better than does tailored supervised exercise with general advice only. Interventions to improve participation in PA should incorporate PA-specific tailored counseling based on sound behavioral theory to promote long-term participation in PA.     

The Effect of Simulating Weight Gain on the Energy Cost of Walking in Unimpaired Children and Children With Cerebral Palsy

Plasschaert F, Jones K, Forward M. The effect of simulating weight gain on the energy cost of walking in unimpaired children and children with cerebral palsy.

Objective

To examine the effect of simulating weight gain on the energy cost of walking in children with cerebral palsy (CP) compared with unimpaired children.

Design

Repeated measures, matched subjects, controlled.

Setting

University hospital clinical gait and movement analysis laboratory.

Participants

Children (n=42) with CP and unimpaired children (n=42).

Interventions

Addition of 10% of body mass in weight belt.

Main Outcome Measures

Energy cost of walking parameters consisting of walking speed, Physiological Cost Index, Total Heart Beat Index, oxygen uptake (V̇o₂), gross oxygen cost, nondimensional net oxygen cost, and net oxygen cost with speed normalized to height were measured by using a breath-by-breath gas analysis system (K4b²) and a light beam timing gate system arranged around a figure 8 track. Two walking trials were performed in random order, with and the other without wearing a weighted belt.

Results

Children with CP and their unimpaired counterparts responded in fundamentally different ways to weight gain. The unimpaired population maintained speed and V̇o₂ but the children with CP trended toward a drop in their speed and an increase in their V̇o₂. The oxygen consumption of children with CP showed a greater dependence on mass than the unimpaired group (P=.043).

Conclusions

An increase of a relatively small percentage in body mass began to significantly impact the energy cost of walking in children with CP. This result highlights the need for weight control to sustain the level of functional walking in these children.     

Effects of mental practice on affected limb use and function in chronic stroke

OBJECTIVE: To determine the efficacy of a mental practice (MP) protocol in increasing the function and use of the more affected limb in stroke patients. DESIGN: Randomized, controlled, multiple baseline, pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Eleven patients who had a stroke more than 1 year before study entry (9 men; mean age, 62.3+/-5.1 y; range, 53-71 y; mean time since stroke, 23.8 mo; range, 15-48 mo; 10 strokes exhibiting upper-limb hemiparesis on the dominant side) and who exhibited affected arm hemiparesis and nonuse. INTERVENTION: All patients received 30-minute therapy sessions 2 days a week for 6 weeks. The sessions emphasized activities of daily living (ADLs): 6 subjects randomly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs; 5 subjects (control group) received an intervention consisting of relaxation techniques. MAIN OUTCOME MEASURES: The Motor Activity Log and Action Research Arm (ARA) test. RESULTS: Affected limb use as rated by MP patients and their caregivers increased (1.55, 1.66, respectively), as did patient and caregiver ratings of quality of movement (2.33, 2.15, respectively) and ARA scores (10.7). In contrast, the controls showed nominal increases in the amount they used their affected limb and in limb function. A Wilcoxon test on the ARA scores revealed significantly ( P =.004) greater changes in the MP group's scores. CONCLUSIONS: Participation in an MP protocol may increase a stroke patient's use of his/her more affected limb. Data further support that the protocol resulted in correlative, MP-induced, motor function improvements. The mechanisms whereby MP increases affected arm use are unknown. Perhaps using the more affected limb becomes more salient through MP, or perhaps motor schema are altered during MP to integrate limb use.     

Reliability and Validity of the Functional Gait Assessment (German Version) in Subacute Stroke Patients

Thieme H, Ritschel C, Zange C. Reliability and validity of the Functional Gait Assessment (German version) in subacute stroke patients.

Objective

To investigate validity and reliability of the Functional Gait Assessment (FGA) (German version) as a measure for balance abilities during walking in subacute stroke patients.

Design

Cohort study.

Setting

Inpatient rehabilitation center.

Participants

Ambulatory subjects (N=28) at a maximum of 6 months after stroke participated in this study. One direct observer and 2 video observers rated the FGA.

Interventions

Not applicable.

Main Outcome Measures

Performance of the FGA was video recorded and directly rated. For testing concurrent validity of the FGA, subjects also completed testing in the Berg Balance Scale, fast walking speed, the Functional Ambulatory Category, the Rivermead Mobility Index, and the Barthel Index. Intrarater reliability, interrater reliability, and concurrent validity of the FGA were analyzed.

Results

Intrarater (intraclass correlation coefficient=.97) and interrater reliability (intraclass correlation coefficient=.94) were almost perfect for total scores. Reliability of single items varied between substantial and almost perfect values. Analysis revealed significant correlations between the FGA and other measures of gait and balance functions between Spearman rho values of .71 and .93. The FGA differs significantly between levels of gait ability (Functional Ambulatory Category) (P≤.01).

Conclusions

Almost perfect intrarater and interrater reliability for total FGA scores and good concurrent validity were shown in this study. Therefore, the FGA (German version) can be used as a reliable and valid tool to assess functional gait performance of patients in subacute stages after stroke.     

Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury

Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.

Objectives

To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.

Design

Case series.

Setting

Tertiary care rehabilitation center.

Participants

Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.

Interventions

50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).

Main Outcome Measures

Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.

Results

A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).

Conclusions

ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.