The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 1: Item generation.

PRIMARY OBJECTIVE: To generate a comprehensive list of items for a scale suitable for assessing high-level mobility in people with traumatic brain injury (TBI). RESEARCH DESIGN: High-level mobility items were generated following a critical evaluation of existing adult and paediatric mobility scales and by surveying expert clinicians for opinions about items appropriate for inclusion on a high-level mobility scale. MAIN OUTCOMES AND RESULTS: The critical evaluation identified 18 different items from 31 mobility scales. These included nine walking items in addition to higher level activities such as stair use, running, jumping and hopping. Expert clinicians generated 157 items that were collated and condensed to 88 items for ranking on a questionnaire. Fifteen items on the questionnaire were rated as very important by 80% of the expert clinicians. These included walking forwards, walking on slopes and different surfaces, changing direction, walking long distances and stair use. Running items included forwards, backwards, on slopes and over different surfaces, changing direction, stopping and starting as well as running long distances. Balancing in single limb stance was also included. CONCLUSION: The final list comprised walking, running, hopping, skipping, jumping and balance items. This initial version of the HiMAT has face and content validity although requires further testing to investigate whether it is uni-dimensional and valid for people with TBI.

The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 2: content validity and discriminability.

PRIMARY OBJECTIVES: (i) To assess the measurement properties of the high-level mobility assessment tool (HiMAT) for people with traumatic brain injury (TBI), (ii) to measure the extent to which the HiMAT is a uni-dimensional, discriminative hierarchical outcome scale. RESEARCH DESIGN: The content validity was assessed using a three-stage process of investigating internal consistency, factor analysis and Rasch analysis. The uni-dimensionality of the HiMAT items was also tested. Discriminability was investigated by correlating raw and logit scores obtained from Rasch analysis. The study was conducted at a major rehabilitation facility using a convenience sample of 103 adults with TBI. MAIN OUTCOMES AND RESULTS: The internal consistency for the high-level items was very high (Cronbach's alpha = 0.99). Principal axis factoring identified several balance items as belonging to a second factor not related to high-level mobility, hence these items were excluded. Rasch analysis identified several misfitting items, such as walking around a figure of eight and stopping from a run, which were also excluded. Logit scores were used to exclude clustered and, therefore, redundant items. Raw scores correlated very highly (r = 0.98) with logit scores, indicating that raw scores provided good discriminability and were suitable for use by clinicians. CONCLUSION: The HiMAT, which assesses higher-level mobility requirements of people with TBI for return to pre-accident social, leisure and sporting activities, is a uni-dimensional and discriminative scale for quantifying therapy outcomes.

Falls and injury prevention should be part of every stroke rehabilitation plan.

OBJECTIVE: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. DESIGN: Prospective cohort study. SETTING: Community. SUBJECTS: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. MAIN MEASURES: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). RESULTS: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05). CONCLUSION: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals' assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.

The Mobility Scale for Acute Stroke Patients: concurrent validity.

OBJECTIVE: A new scale, the Mobility Scale for Acute Stroke Patients (MSAS), was developed to specifically discriminate between the lower levels of mobility found in acute stroke patients in the first two weeks post onset. The aim of this study was to investigate the concurrent validity of this new scale with other established scales. MAIN OUTCOME MEASURES: Concurrent validity was assessed with respect to four other well-validated measures: Motor Assessment Scale (MAS), Functional Ambulation Classification system (FAC), Functional Independence Measure (FIM), and Barthel Index (BI). The measures selected for comparison contained items similar to those in the MSAS. SUBJECTS: From a total of 539 patients who were admitted over a two-year period with a primary diagnosis of stroke, 106 satisfied the criteria for inclusion in this study. RESULTS: The MSAS was found to have a high level of concurrent validity (r > 0.80) when the total score was correlated with the total scores of the MAS, FAC, FIM (mobility and ADL) and BI. A high level of association was found between the nonbed mobility items (sit to stand, stand and walk) of the MSAS and the mobility items (toileting, transfers, walk and stairs) of the FIM and BI. There was a weaker association between the MSAS items and the ADL items (activities of daily living) of the BI and FIM. CONCLUSION: A new scale designed specifically for acute stroke patients was found to have a high degree of concurrent validity when compared with four other scales containing similar items.

Effect of stroke on step characteristics of obstacle crossing.

OBJECTIVE: To compare spatial and temporal measures during lead limb obstacle crossing between subjects with stroke and healthy subjects. DESIGN: Experimental, observational, with matched controls. SETTING: Geriatric rehabilitation unit in a tertiary referral hospital. PARTICIPANTS: Distance data were available for 19 subjects with stroke and 19 able-bodied subjects. Temporal data were available for 16 subjects with stroke and 16 able-bodied subjects. Subjects with stroke were inpatients and had to be able to walk 10 meters without assistance or gait aid. INTERVENTION: Subjects were required to step over high and wide obstacles, ranging from 1 to 8cm, and trials were videotaped. MAIN OUTCOME MEASURES: Toe clearance, preobstacle distance, postobstacle distance, step length, proportion of step length preobstacle, step time, preobstacle step time, postobstacle step time, and proportion of step time preobstacle were measured. RESULTS: Mann-Whitney U tests were performed to determine differences between the 2 groups. Subjects with stroke had significantly higher toe clearance, smaller postobstacle distances, and greater step times than healthy subjects. Subjects with stroke did not demonstrate a significant reduction in preobstacle distance. CONCLUSION: By modifying their lead limb trajectory during obstacle crossing, persons with stroke reduce the risk of a trip due to toe contact, but the modification may expose them to other safety risks.

Theoretical considerations in balance assessment.

Although balance control is an integral component of all daily activities, its complex and flexible nature makes it difficult to assess adequately. This paper discusses balance by examining it in relation to function and the physical environment. Balance is affected by both the task being undertaken and the surroundings in which it is performed. Different tasks and environments alter the biomechanical and information processing needs for balance control. These issues are discussed and a modification of Gentile s Taxonomy of Tasks is suggested for analysis of clinical balance tests, some of which are used as examples.

Development of a new mobility scale for people living in the community after stroke: content validity.

Mobility inside and outside the home, and in the community, is important to independence of lifestyle after stroke. Existing measures lack content validity relating to these three environments. The aim of this study was to contribute to the content validity phase of developing a new scale for assessing mobility of people with stroke in these settings. An open-ended questionnaire was used to obtain responses from 15 physiotherapists with substantial experience in neurological physiotherapy. Responses were coded to provide a comprehensive list of tasks and destinations. A wide range of destinations was identified for i) inside the home: bedroom, bathroom/toilet, living room, kitchen; ii) outside the home: access to and from property, outside buildings, clothes line, garden and letterbox; iii) in the community: access to health and shopping facilities, leisure sites and public transport. Although a diverse range of tasks was identified, a common theme emerged to emphasise the impact of the environment on mobility. Responses were recorded in all dimensions of a recently published conceptual model of mobility that focused on environment. These dimensions included distance, time constraints, ambient conditions, terrain characteristics, external physical load, attentional demands, postural transitions and traffic level. Further work is required to quantify environmental dimensions which are relevant to the destinations identified in the three environmental settings of this study.

A prospective study of injuries in basketball: a total profile and comparison by gender and standard of competition.

The study aimed to determine prospectively a basketball injury profile, including severity of injury, and to compare the injury profile by gender and standard of competition. Trained observers viewed basketball games, noting the occurrence of injuries, and confirmed injuries by questioning all players on site after the game. Injured players completed a questionnaire and the progress of their injury was monitored by telephone interview. A total of 10,393 basketball participations were observed. An overall injury rate was documented of 18.3 per 1,000 participations (24.7 per 1,000 playing hours), and was comparable by gender and standard of competition. Serious injuries (missing one or more weeks of play) occurred at a rate of 2.89/1,000 participations; with the ankle joint the most common serious injury (1.25/1,000 participations), followed by the calf/anterior leg (0.48/1,000 participations) and knee joint (0.29/1,000 participations). The severity of the injury was significantly associated with the body region injured, with more serious injuries incurred to the lower limb than other body regions (p <.05). The severity of the injury incurred was not related to the standard of competition, gender, age, height, number of games played per week, amount of training undertaken, type of injury, or the mechanism of injury (p> .05).

Gait after stroke: initial deficit and changes in temporal patterns for each gait phase.

OBJECTIVE: To examine which phases of the gait cycle contributed to decreased gait velocity after stroke. DESIGN: Experimental. SETTING: Inpatient rehabilitation centers. PARTICIPANTS: Forty-two patients with unilateral first stroke who were able to walk 10 meters; and 42 age- and gender-matched controls with no history of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Deficit and change expressed as duration (s) and proportion (%) for the 4 phases of the gait cycle at the time of admission to rehabilitation (test 1), a median of 31 days poststroke onset, and again 8 weeks later (test 2). Affected and unaffected single-limb support (SLS) and initial double-limb support (DLS) were compared. RESULTS: At tests 1 and 2, the durations of the 2 DLS and unaffected SLS phases were significantly (p <.001) longer in the stroke patients than in control subjects. No difference was found between the 2 groups for duration of affected SLS at either test time. Significant (p <.001) decreases occurred over the 8-week period in the 3 phases identified to be abnormally long at test 1. CONCLUSION: If the goal of rehabilitation is to increase gait velocity and normalize the gait pattern, treatment should focus on decreasing the DLS and unaffected SLS phases of the gait cycle.

Validity of motor tasks for predicting running ability in acquired brain injury.

INTRODUCTION: Rehabilitation of running following traumatic brain injury (TBI) has the potential to enhance quality of life. Retraining of running following TBI has not been previously reported in the literature. In response to a lack of information about which motor tasks should be included in a retraining programme, this study aimed to investigate performance predictors of running ability. METHOD: Forty TBI subjects (20 runners and 20 non-runners) performed four specific motor tasks which were selected on the basis of theory and clinical experience with TBI subjects. The four tasks included bounding onto a leg, walking on toes, stepping backwards up a step, and balancing on one leg. Subjects were generally extremely severely brain damaged (median post-traumatic amnesia >28 days), had suffered multiple leg fractures and had received greater than 8 months rehabilitation. RESULTS: The four motor tasks differentiated significantly between the two groups (p < 0.001) and were all strong predictors of running ability. The presence of a non-support phase (NSP) during the bounding task was the strongest predictor of running ability. Logistic regression indicated that TBI subjects who could execute a NSP into a single bound were 24.6 times more likely to be able to run than subjects who could not. When the four tasks were used in combination, two tasks were identified by logistic regression: (1) ability to execute a free-float phase during a bound, and (2) balancing on one leg. All four motor tasks had high retest reliability, with proportional indices of reliability ranging from 0.92-0.97. No statistically significant difference was found between runners and non-runners for group characteristics such as age, severity of injury (length of PTA), orthopaedic leg injuries and time post-injury (p > 0.05). These characteristics were not shown to influence the ability to run following TBI. CLINICAL IMPLICATIONS: The four motor tasks were strong predictors of running ability. Severity and type of injury were not factors influencing ability to run. This study provides preliminary evidence about the motor tasks which have the potential to be used in a running programme. No casual relationship has been identified. The next step is to investigate whether training in these tasks is effective in the rehabilitation of running following TBI.

Ankle injuries in basketball: injury rate and risk factors.

OBJECTIVES: To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players. METHODS: Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire. RESULTS: A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06). CONCLUSIONS: Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.

Reliability of measurement of angular movements of the pelvis and lumbar spine during treadmill walking.

BACKGROUND AND PURPOSE: Angular movements of the pelvis and lumbar spine are thought to play an important role in walking. However, little is known about the amount of unpredictable variability in measurement of these movements during human walking. The aim of the present study was to determine the retest reliability of measuring the angular movements of the pelvis and lumbar spine during unimpaired familiarized treadmill walking. METHOD: Retest reliability for 26 subjects without pathology was determined over a one-week interval. Subjects walked on a treadmill at self-selected or a slower speed while measurements of the three-dimensional angular movements were taken with a computer-based video analysis system. RESULTS: The frontal plane movements of pelvic list and lumbar lateral flexion (relative to the pelvis) could be measured with high retest reliability at both self-selected and slow walking speeds (intraclass coefficient (ICC) (2, 1) > or = 0.81). In contrast, transverse and sagittal plane movements demonstrated moderate reliability at both speeds (0.37 < or = ICC (2, 1) < or = 0.76). Averaging the measurement over six strides resulted in increased observed reliability (self-selected walking speed summary Pearson's r = 0.71, slow walking speed summary Pearson's r = 0.79) compared to taking the measurement based on a single stride (self-selected walking speed summary Pearson's r = 0.63, slow walking speed summary Pearson's r = 0.67). Unlike pelvic and lumbar movements (relative to the pelvis), the measurement of lumbar movements (relative to the global reference frame) appeared to depend on whether subjects were walking at self-selected or slow speeds. CONCLUSIONS: Measurement of pelvic list and lumbar lateral flexion (relative to the pelvis) could be applied with confidence to hypothesis testing about individuals or groups. Movements in the transverse and sagittal planes are unlikely to be appropriate in hypothesis testing about individuals and hence clinical practice, but may still have experimental applications in hypothesis testing about groups.

Visual judgements of steadiness in one-legged stance: reliability and validity.

BACKGROUND AND PURPOSE: There is a paucity of information about the validity and reliability of clinicians' visual judgements of steadiness in one-legged stance. Such judgements are used frequently in clinical practice to support decisions about treatment in the fields of neurology, sports medicine, paediatrics and orthopaedics. The aim of the present study was to address the validity and reliability of visual judgements of steadiness in one-legged stance in a group of physiotherapists. METHOD: A videotape of 20 five-second performances was shown to 14 physiotherapists with median clinical experience of 6.75 years. Validity of visual judgement was established by correlating scores obtained from an 11-point rating scale with criterion scores obtained from a force platform. In addition, partial correlations were used to control for the potential influence of body weight on the relationship between the visual judgements and criterion scores. Inter-observer reliability was quantified between the physiotherapists; intra-observer reliability was quantified between two tests four weeks apart. RESULTS: Mean criterion-related validity was high, regardless of whether body weight was controlled for statistically (Pearson's r = 0.84, 0.83, respectively). The standard error of estimating the criterion score was 3.3 newtons. Inter-observer reliability was high (ICC (2,1) = 0.81 at Test 1 and 0.82 at Test 2). Intra-observer reliability was high (on average ICC (2,1) = 0.88; Pearson's r = 0.90). The standard error of measurement for the 11-point scale was one unit. CONCLUSIONS: The finding of higher accuracy of making visual judgements than previously reported may be due to several aspects of design: use of a criterion score derived from the variability of the force signal which is more discriminating than variability of centre of pressure; use of a discriminating visual rating scale; specificity and clear definition of the phenomenon to be rated.

Angular movements of the pelvis and lumbar spine during self-selected and slow walking speeds.

We studied the effect of walking at a self-selected and at a slower speed on the angular movements of the pelvis and lumbar spine. We also studied how interpretation of speed effects on lumbar spine movements was influenced by frame of reference, either relative to the pelvis or relative to a global reference frame. Twenty-seven subjects without pathology walked on a treadmill at either self-selected or 60% of self-selected speed. The movements of the pelvis and lumbar spine, as represented by surface markers, were recorded by videocameras and the three-dimensional angles computed by the PEAK motion measurement system. Results indicated that the amplitudes of pelvic list (P<0.05) and pelvic axial rotation (P<0. 05) were decreased at slow walking speed. Relative to the pelvis, the amplitude of lumbar lateral flexion was decreased with slower walking (P<0.01). In contrast, when lumbar spine movements were measured relative to a global reference frame, no differences were detected due to decreased walking speed. This suggests, firstly, that the effect of walking speed when evaluating the significance of decreased movements of the pelvis and of the lumbar spine (relative to the pelvis) of subjects walking at slower than self-selected speeds should be considered and secondly, that movement of the lumbar spine should be interpreted with respect to a frame of reference.

Obstacle crossing in subjects with stroke.

OBJECTIVE: To study the ability of subjects with stroke to successfully step over an obstacle during ambulation. SETTING: A geriatric rehabilitation unit in a tertiary referral hospital. SUBJECTS: Twenty-four inpatients with stroke (median time poststroke 27 days, interquartile range 21 to 44.5 days) able to walk 10 m unassisted without walking aids; also, 22 healthy subjects. METHOD: Subjects were required to step over obstacles of various heights and widths, ranging from 1cm to 8cm. A fail was scored if the obstacle was contacted by either lower limb or if assistance or upper limb support was required. The choice of leading limb and the presence of visual deficits and neglect were also recorded in the stroke subjects. Subjects were tested on two occasions. RESULTS: Significantly more fails were recorded for stroke subjects, with 13 subjects failing at least once. No preference was shown for leading either with the affected or with the unaffected leg. Stroke subjects showed inconsistent performance over the two testing sessions. CONCLUSION: The ability to negotiate obstacles was compromised and inconsistent in stroke subjects undergoing inpatient rehabilitation. This suggests that gait safety in this population remains threatened.

Walking speed on parquetry and carpet after stroke: effect of surface and retest reliability.

OBJECTIVE: At the transition stage from rehabilitation to home this study aimed to (1) investigate the effect of floor surface (carpet and parquetry) on walking speed; (2) investigate whether there was a difference between these surfaces as stroke patients voluntarily increased from comfortable to fast pace; (3) investigate whether walking speed on parquetry was a predictor of walking speed on carpet at the two paces; (4) investigate whether walking speed at a comfortable pace was a predictor of walking speed at a fast pace on the two surfaces; and (5) quantify systematic and random error in repeated measurements for fast-paced walking trials. DESIGN: Subjects walked 10 metres at comfortable and fast paces on carpet and parquetry on two consecutive days. SETTING: Inpatient rehabilitation centre. SUBJECTS: Twenty-four stroke patients. MAIN OUTCOME MEASURE: Walking speed. RESULTS: Two-way analysis of variance confirmed that patients walked more slowly on carpet than parquetry (F(1,23) = 5.3, p <0.05) at both paces; the interaction effect was not significant (p >0.05). Walking speed on parquetry was a strong predictor of walking speed on carpet at a comfortable (r = 0.92), and fast pace (r = 0.97). Walking speed at comfortable pace was a moderately strong predictor of walking speed at fast pace on parquetry (r = 0.84), and on carpet (r = 0.88). Random error in repeated measurements was higher when walking fast on carpet (7.21 m/min) and parquetry (8.32 m/min) than when walking at a comfortable pace on carpet (4.63 m/min) and parquetry (3.48 m/min). Systematic error was negligible (p <0.05). CONCLUSION: Carpet surface was more challenging than parquetry surface, as evidenced by the systematic decrease in walking speed. This may have been due to lack of familiarity. Relative to the wide range of scores in the group, stroke patients showed consistency of walking speed across both surfaces. Likewise, stroke patients retained their relative position in the group as they changed from a comfortable to a fast walking pace. The difference in random error between comfortable and fast-paced trials highlights the need to quantify error in the repeated measurement situation according to specific test conditions.

Prediction of gait velocity in ambulatory stroke patients during rehabilitation.

OBJECTIVE: To quantify prediction of gait velocity in ambulatory stroke patients during rehabilitation. DESIGN: Single group (n = 42) at the beginning of rehabilitation (Test 1) and 8 weeks later (Test 2). SETTING: Inpatient rehabilitation. PATIENTS: Unilateral first stroke; informed consent; able to walk 10 meters. INDEPENDENT VARIABLES: Gait velocity at Test 1, age, time from stroke to Test 1, side of lesion, neglect. DEPENDENT VARIABLES: Gait velocity at Test 2, gait velocity change. RESULTS: The correlation between initial gait velocity and gait velocity outcome at Test 2 was of moderate strength (r2 = .62, p<.05). However, even at its lowest, the standard error of prediction for an individual patient was 9.4 m/min, with 95% confidence intervals extending over a range of 36.8 m/min. Age was a weak predictor of gait velocity at Test 2 (r2 = -.10, p<.05). Gait velocity change was poorly predicted. The only significant correlations were initial gait velocity (r2 = .10, p<.05) and age (r2 = .10, p<.05). CONCLUSION: While the prediction of gait velocity at Test 2 was of moderate strength on a group basis, the error surrounding predicted values of gait velocity for a single patient was relatively high, indicating that this simple approach was imprecise on an individual basis. The prediction of gait velocity change was poor. A wide range of change scores was possible for patients, irrespective of their gait velocity score on admission to rehabilitation.

Tobiano spotting pattern in horses: linkage of To with AlA and linkage disequilibrium.

In a study of 2,786 tobiano and non-tobiano horses involved in paint horse breeding programs throughout the United States, the inheritance of the tobiano color pattern gene was tracked in pedigrees using the tightly linked polymorphic albumin gene. The dominant tobiano allele (T(o)), which produces the tobiano spotting pattern in horses, was in coupling with both AIA and AIB alleles at the albumin locus. The frequency of the T(o):AIA linkage phase among all the homozygous tobiano horses in this study including offspring and parents (N = 127), was 0.08. The T(o):AIB linkage phase was the most frequent (0.92). Linkage disequilibrium exists between the tobiano and albumin loci. The linkage disequilibrium parameter (D) was calculated as D = 0.056 at 79% of maximum linkage disequilibrium.

Quantifying lateral pelvic displacement during walking.

OBJECTIVE: The purpose of this investigation was to test a new procedure for quantifying lateral pelvic displacement during walking. DESIGN: A quasi-experimental design was used to quantify the gait of 18 unimpaired people and one person with hemiplegia. BACKGROUND: Although previous techniques provided useful information on amplitude of lateral pelvic displacement, they did not consider step-to-step variations in walking direction or enable quantification of symmetry. METHODS: Three-dimensional motion analysis was used to collect the coordinates of light-reflective markers placed on the scarum and heels of each subject. Subjects performed one 10 m overground walk at their preferred speed. Amplitude and symmetry of lateral pelvic displacement were quantified relative to the step-to-step variation in the path of motion (base of support). RESULTS: The mean amplitude of lateral pelvic displacement for the unimpaired group was 40.8 mm, and symmetry was 3.1 mm. The amplitude of lateral pelvic displacement for the hemiplegic person was 88.4 mm. Symmetry was 30.9 mm, with deviation toward the non-paretic side. CONCLUSION: The new procedure provided information on the amplitude and symmetry of lateral pelvic displacement in unimpaired adults and was sensitive to deviations of a person with a walking abnormality. RELEVANCE: Treatment of atypical lateral pelvic displacement is frequently an aim of stroke rehabilitation. Therefore, it is important to have objective, accurate methods of quantification.

Systematic and random error in repeated measurements of temporal and distance parameters of gait after stroke.

OBJECTIVE: To obtain intersession estimates of error for temporal and distance (TD) parameters of gait in a sample of stroke patients undertaking inpatient rehabilitation. DESIGN: Thirty-one stroke patients were measured with an instrumented footswitch system (after a median of 46 days poststroke; interquartile range = 26 to 63) walking over a 10-meter distance a total of four times on 3 consecutive days. Two familiarization walks provided intrasession retest data. RESULTS: Metric estimates of systematic and random error have been provided for obtained TD parameters. Proportional indices of reliability (ICC [2,1] and Pearson's r) were generally high, ranging from .72 to .94. CONCLUSION: By quantifying systematic and random error associated with the process of repeated measurements, criteria have been provided for evaluating change in TD variables during rehabilitation. Although error for gait velocity was small relative to individual differences in the stroke group, it was large relative to levels of change derived from measurements reported during typical periods of rehabilitation. Serial measurements of gait during rehabilitation may be better than two consecutive measurements. This study highlights the need to interpret estimates of error according to the purpose of measurement.