Measuring Community Mobility in Survivors of Stroke Using Global Positioning System Technology: A Prospective Observational Study.

BACKGROUND AND PURPOSE: Returning to community mobility is important for people recovering from a stroke, yet few studies have directly measured this construct following inpatient rehabilitation. Using global positioning system (GPS) technology, we examined community mobility of survivors of stroke (SS) over the first year after discharge and compared them to an age-matched comparison group without neurological impairment. METHODS: We conducted a prospective observational study that included SS (n = 14) and age- and location-matched comparison subjects (CS; n = 6). All participants identified target locations important to their community mobility goals and wore a GPS unit during the first, fifth and ninth weeks after discharge, or from baseline for CS, and at 26 and 52 weeks' follow up. The 6-minute walk test (SMWT), Berg balance test (BBT), Reintegration to Normal Living (RNLI), and Short Form-36 Quality of Life Survey Physical Functioning domain (SF-36-PF) were collected. Number of trips and percentage of targets visited were extracted from GPS data. RESULTS: Twelve of 14 SS completed 9 weeks, 7 completed the full year, and no CS withdrew. The SS took fewer trips and attained fewer targets compared with CS at weeks 1 and 9, but not at weeks 5, 26, and 52. All 4 clinical outcome measures were significantly correlated to trips (Spearman r for SMWT = 0.5067, BBT = 0.3841, RNLI = 0.4119, and SF-36-PF = 0.4192). DISCUSSION AND CONCLUSIONS: Directly measured community mobility in SS was decreased through 9 weeks following discharge from inpatient rehabilitation. The limited strength of bivariate correlations between clinical measures and number of trips supported the uniqueness of the community mobility construct.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A277).

Pregait balance rehabilitation in acute stroke patients.

Rehabilitation interventions designed to enhance balance control in individuals with acute stroke are quite limited. The goal was to develop and assess a technique of early pregait balance training involving the use of a combination of force platform visual feedback and the unweighting system in individuals with recent stroke. A total of 28 individuals with acute stroke were randomly divided into the experimental and control groups: individuals included in the experimental group received 1 week of treatment on the basis of retraining balance utilizing visual biofeedback (Balance Master) while provided with a body weight support harness system, whereas the individuals in the control group received conventional treatment. Both the groups undertook identical tests (Fugl-Meyer Balance test, Functional Independence Measure test for gait, and Fugl-Meyer lower extremity assessment) before the start of treatment and after its completion. Individuals in the experimental group showed larger gains as seen in the increased scores of the Fugl-Meyer Balance test and the Functional Independence Measure test for gait as compared with the control group. The outcome of the study provides a basis for future investigations of the applicability of the intervention in early balance rehabilitation of individuals with neurological disorders.

Monitoring community mobility with global positioning system technology after a stroke: a case study.

BACKGROUND: Stroke survivors often experience difficulty returning to activities and places they deem important to their social, leisure, and occupational aspirations. The extent to which stroke survivors return to community mobility and their ability to navigate and access locations they deem meaningful have not been objectively measured. PURPOSE: We used global positioning system technology (GPSt) to measure the community mobility of a person poststroke, and assess the relationship between GPSt measures and clinical measures of mobility. METHODS: : The participant was a 56-year-old man who sustained a right pontine stroke. At discharge from rehabilitation, his Six-Minute Walk Test distance was 73 m. He was fitted with a GPS unit and an accelerometer attached to a single belt and instructed to wear the devices at all times when out of bed. After identifying 10 locations that were important to his goals, he was monitored for 5 separate 1-week periods, on the first, fifth, and ninth weeks and at 6 and 12 months after discharge. RESULTS: During the first 10 weeks, he averaged 7.6 target visits (70%) and 26.7 trips per week. At 1 year, his Six-Minute Walk distance score was 287.5 m. Accelerometry data revealed that he remained primarily sedentary. Target visits and trips per week did not change substantially over the course of 1 year, and compliance wearing the GPS unit was variable. CONCLUSIONS: Given the limited correlation in gait speed and distance with target attainment and trips, these outcomes likely measure different constructs for this subject. GPSt may offer insights into participation for stroke survivors following rehabilitation.