‘Magic’ number of treadmill sessions needed to achieve meaningful change in gait speed post stroke

Abstract Objective The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. Impact Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

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O24 Gait Profile Score in post-stroke subjects accounting for the effect of gait speed

Gait & Posture ◽

10.1016/j.gaitpost.2017.06.277 ◽

2017 ◽

Vol 57 ◽

pp. 44

Author(s):

Claudiane Fukuchi ◽

Richard Baker ◽

Marcos Duarte

Keyword(s):

Gait Speed ◽

Post Stroke ◽

Profile Score

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Effects of gait rehabilitation with a footpad-type locomotion interface in patients with chronic post-stroke hemiparesis: a pilot study

Clinical Rehabilitation ◽

10.1177/0269215511432356 ◽

2012 ◽

Vol 26 (8) ◽

pp. 686-695 ◽

Cited By ~ 20

Author(s):

Naoki Tanaka ◽

Hideyuki Saitou ◽

Toshifumi Takao ◽

Noboru Iizuka ◽

Junko Okuno ◽

...

Keyword(s):

Pilot Study ◽

Sample Size ◽

Gait Speed ◽

Chronic Stroke ◽

Gait Rehabilitation ◽

Stroke Patients ◽

Timed Up And Go ◽

Intervention Phase ◽

Post Stroke ◽

Locomotion Interface

Objective: We developed a footpad-type locomotion interface called the GaitMaster. The purpose of this pilot study was to examine the effects of gait rehabilitation using the GaitMaster in chronic stroke patients. Design: Randomized cross-over design. Setting: An outpatient department. Subjects: Twelve patients with chronic post-stroke hemiparesis. Intervention: In group A, patients underwent an ‘intervention phase’ followed by a ‘non-intervention phase’, whereas in group B, patients underwent the non-intervention phase first, followed by the intervention phase. In the four- or six-week intervention phase, participants underwent twelve 20-minute sessions of gait rehabilitation using the GaitMaster4. Main outcome measures: We measured gait speed and timed up-and-go test. Results: No differences between the two groups were observed in the baseline clinical data. For the combined groups A and B, the maximum gait and timed up-and-go test speeds improved significantly only in the intervention phase ( P = 0.0001 and P = 0.003, respectively). The percentages of improvement from baseline at the end of GaitMaster training were 16.6% for the maximum gait speed and 8.3% for the timed up-and-go test. The effect size for GaitMaster4 training was 0.58 on the maximum gait speed and 0.43 on the timed up-and-go test. Conclusions: This pilot study showed that gait rehabilitation using the GaitMaster4 was a feasible training method for chronic stroke patients. Calculation of the sample size indicated that a sample size of 38 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation for chronic stroke patients in a future randomized controlled trial.

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Increases in overground gait speed with body weight support in people post-stroke

2009 IEEE International Conference on Rehabilitation Robotics ◽

10.1109/icorr.2009.5209530 ◽

2009 ◽

Cited By ~ 2

Author(s):

Jamie K. Burgess ◽

Gwendolyn Weibel ◽

David A. Brown

Keyword(s):

Body Weight ◽

Gait Speed ◽

Body Weight Support ◽

Post Stroke ◽

Weight Support

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Simulated hemiparesis increases optimal spatiotemporal gait asymmetry but not metabolic cost

10.1101/2021.12.20.473515 ◽

2021 ◽

Author(s):

Russell T Johnson ◽

Nicholas August Bianco ◽

James Finley

Keyword(s):

Gait Speed ◽

Metabolic Cost ◽

The Body ◽

Musculoskeletal Modeling ◽

Cost Of Transport ◽

Gait Patterns ◽

Post Stroke ◽

The Cost ◽

Future Work ◽

Isometric Muscle

Several neuromuscular impairments, such as weakness (hemiparesis), occur after an individual has a stroke, and these impairments primarily affect one side of the body more than the other. Predictive musculoskeletal modeling presents an opportunity to investigate how a specific impairment affects gait performance post-stroke. Therefore, our aim was to use to predictive simulation to quantify the spatiotemporal asymmetries and changes to metabolic cost that emerge when muscle strength is unilaterally reduced. We also determined how forced spatiotemporal symmetry affects metabolic cost. We modified a 2-D musculoskeletal model by uniformly reducing the peak isometric muscle force in all muscles unilaterally. We then solved optimal control simulations of walking across a range of speeds by minimizing the sum of the cubed muscle excitations across all muscles. Lastly, we ran additional optimizations to test if reducing spatiotemporal asymmetry would result in an increase in metabolic cost. Our results showed that the magnitude and direction of effort-optimal spatiotemporal asymmetries depends on both the gait speed and level of weakness. Also, the optimal metabolic cost of transport was 1.25 m/s for the symmetrical and 20% weakness models but slower (1.00 m/s) for the 40% and 60% weakness models, suggesting that hemiparesis can account for a portion of the slower gait speed seen in people post-stroke. Adding spatiotemporal asymmetry to the cost function resulted in small increases (~4%) in metabolic cost. Overall, our results indicate that spatiotemporal asymmetry may be optimal for people post-stroke, who have asymmetrical neuromuscular impairments. Additionally, the effect of speed and level of weakness on spatiotemporal asymmetry may explain the well-known heterogenous distribution of spatiotemporal asymmetries observed in the clinic. Future work could extend our results by testing the effects of other impairments on optimal gait strategies, and therefore build a more comprehensive understanding of the gait patterns in people post-stroke.

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Factors contributing to post-stroke health care utilization and costs. Secondary results from the Life After Stroke (LAST) study, a pragmatic randomized controlled trial

10.21203/rs.2.17944/v2 ◽

2020 ◽

Author(s):

Øystein Døhl ◽

Vidar Halsteinli ◽

Torun Askim ◽

Mari Gunnes ◽

Hege Ihle Hansen ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Gait Speed ◽

Standard Care ◽

Controlled Trial ◽

Health Care Use ◽

Post Stroke ◽

Randomized Controlled ◽

Care Costs

Abstract Background The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. Methods The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n=186) or standard care (n=194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. Results There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5L. Conclusion Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. Clinical Trial Registration : https://www.clinicaltrials.gov NCT01467206.

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Assessment of test-retest reliability and internal consistency of the Wisconsin Gait Scale in hemiparetic post-stroke patients

Advances in Rehabilitation ◽

10.1515/rehab-2015-0048 ◽

2016 ◽

Vol 30 (3) ◽

pp. 41-53 ◽

Cited By ~ 4

Author(s):

Agnieszka Guzik ◽

Mariusz Drużbicki ◽

Grzegorz Przysada ◽

Andrzej Kwolek ◽

Agnieszka Brzozowska-Magoń ◽

...

Keyword(s):

Motor Control ◽

Internal Consistency ◽

Lower Limb ◽

Barthel Index ◽

Gait Speed ◽

Muscle Tone ◽

Stroke Patients ◽

Retest Reliability ◽

Post Stroke ◽

Test Retest Reliability

Abstract Introduction: A proper assessment of gait pattern is a significant aspect in planning the process of teaching gait in hemiparetic post-stroke patients. The Wisconsin Gait Scale (WGS) is an observational tool for assessing post-stroke patients’ gait. The aim of the study was to assess test-retest reliability and internal consistency of the WGS and examine correlations between gait assessment made with the WGS and gait speed, Brunnström scale, Ashworth’s scale and the Barthel Index. Material and methods: The research included 36 post-stroke patients. The patients’ gait was assessed with the use of the Wisconsin Gait Scale, gait speed with the use of walk test, the level of motor control in a paretic lower limb – according to Brunnström recovery stages, muscle tone in a paretic lower limb – according to modified Ashworth’s scale and functional independence was assessed using the Barthel Index. Gait was assessed with the use of the WGS twice, with a 7-day interval, by three experienced physiotherapists. Results: The analysis of internal consistency of the WGS revealed that the Cronbach’s α coefficient was high in the case of all the three raters and ranged from 0.85 to 0.88. It was noted that the coefficient of variation for all the comparisons was below 10%. When assessing the repeatability of the results, it was revealed that correlations between both measurements made by particular raters were very strong and highly significant. The WGS results significantly correlated with Brunnström scale, Ashworth’s scale and gait speed. Conclusions: It was concluded that the WGS has a high internal consistency and test-retest reliability. Also, significant correlations were found between gait assessment made with the use of the WGS and gait speed, level of motor control and muscle tone of a paretic lower limb. The WGS constitutes a promising tool for a qualitative, observational analysis of gait in post-stroke patients and allows for proper planning, monitoring and assessing rehabilitation results.

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