Factors related to community ambulation in patients with chronic stroke

Abstract

The focus of gait rehabilitation for walking in real-life settings should vary according to different aspects of gait performance. Investigation of factors related to impairments specific to community ambulation or activity participation may be helpful in determining and targeting appropriate treatment for gait rehabilitation. Objective To investigate the relationship between community ambulation and factors determining gait ability. Methods Forty-six outpatients with a previous stroke participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included impairments (strength, sensation, muscle tone, and balance) and ambulatory activity limitations (self-paced and maximum 10-m gait speed, 6-minute walking test, and concurrent manual/cognitive dual-task walking speed). Ability to increase speed and the dual-tasks cost were calculated. Multivariate analysis of variance and multiple regression analyses were used to determine differences in walking and identify important factors related to community ambulation. Results Pearson and Spearman analyses revealed that impairments (balance, r = .665; muscle strength, r = 0.653) and ambulatory activity limitation (gait speed, r = 0.684; walking distance, r = 0.654; ability to increase speed, r = 0.413) were significantly positively correlated with community ambulation level. Balance was an important factor in predicting increasing speed (P < 0.001). Muscle strength and tone were positive contributors to gait speed (P = 0.001 for both) and distance (P = 0.019 and P = 0.002, respectively). Cognitive and manual dual tasks showed no significant relationship to other variables. Stepwise multivariate regression analysis showed that important determinants of community ambulation level were strength (P < 0.001) and gait endurance (P = 0.001). Conclusions Muscle strength and walking distance are contributing factors in community ambulation for patients with chronic stroke.

Balance impairment limits ability to increase walking speed in individuals with chronic stroke

“…Although BBS scores were associated with WSR values among those who used an assistive device and those who did not, the association appears stronger for those who used a device (Spearman’s r =0.39 for no assistive device and 0.65 for assistive device, p < 0.001). Lee et al [14] previously reported an association between balance impairments and the ability to increase WS in individuals with chronic stroke who did not require an assistive device. Our findings expand on that work by demonstrating that this relationship exists, and may actually be stronger, in those who require an assistive device for ambulation.…”

“…[14] However, slower walkers are less able to increase their speed on demand [6] and also demonstrate reduced balance compared to faster walkers. [1] This suggests that individuals post-stroke may be unable to access their “reserve” due to diminished balance.…”

“…Specifically, the Berg Balance Scale (BBS) has been related to the ability to increase WS in higher functioning individuals post-stroke who walked without an assistive device. [14] Exclusion of individuals who use an assistive device represents a notable limitation given that up to 43% of this population relies on an assistive device for mobility. [15,16]…”

The prevalence, distribution, and functional importance of lower limb somatosensory impairments in chronic stroke survivors: a cross sectional observational study

“…Whilst the majority of stroke survivors gain "independent walking" [3], up to 50% of chronic stroke survivors regularly request a companion when walking outdoors [4]. Mobility issues such as reduced balance [5], walking speed and endurance [6,7], and falls [8] have been demonstrated in people several years after stroke. The effect on individuals, health care systems, and society suggest a greater need to focus attention on the long-term consequences, management, and rehabilitation of people with stroke to reduce the global stroke burden is thus needed [2].…”

Discriminative validity of the timed up and go test for community ambulation in persons with chronic stroke

“…Therefore, the clinicians should identify relevant variables and assessment tools to predict independence of ambulation. Community gait ability is related to several factors such as perception, balance, and muscle strength [22]. The TUG test consists of consecutive tasks as standing up from a chair, walking forward, turning, coming back, and sitting down on the chair.…”