Changes in physical activity level during hospitalization in patients with stroke and those with fracture: a prospective longitudinal study.

[Purpose] To examine changes in physical activity levels between admission and discharge in patients hospitalized after stroke and fracture. [Participants and Methods] Patients with stroke (n=36) or fracture (n=41) wore an accelerometer during the daytime for three days after admission and before discharge. Physical activity was divided into sedentary behavior (SB), light-intensity (LIPA), and moderate-to-vigorous (MVPA), and then compared between hospital admission and discharge using the Wilcoxon signed-rank test. The characteristics of patients with or without changes in SB during hospitalization were compared using the Mann-Whitney U test. [Results] The median LIPA time in patients after stroke and fracture increased from 107.5 and 106.7 minutes on admission to 122.0 and 127.3 minutes at discharge, and the median MVPA time increased from 2.7 and 0.7 minutes on admission to 4.2 and 2.7 minutes at discharge, respectively. In particular, LIPA in non-therapy time increased for patients both after stroke and fracture. No differences in characteristics were observed between with or without changes in SB regardless of differences in diagnoses. [Conclusion] These findings indicate that while physical activity levels increased during hospitalization, they remained below World Health Organization recommendations for MVPA, and patient characteristics alone may not account for increased activity levels.

Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke.

[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6-0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.

Predictors of life-space mobility in patients with fracture 3 months after discharge from convalescent rehabilitation ward: a prospective longitudinal study.

[Purpose] To identify predictors of life-space mobility in patients with fracture three months after discharge from convalescent rehabilitation ward. [Participants and Methods] This is a prospective longitudinal study that included patients aged 65 or older with a fracture who were scheduled for discharge home from the convalescent rehabilitation ward. Baseline measurements included sociodemographic variables (age, gender, and disease), the Falls Efficacy Scale-International, maximum walking speed, the Timed Up & Go test, the Berg Balance Scale, the modified Elderly Mobility Scale, the Functional Independence Measure, the revised version of Hasegawa's Dementia Scale, and the Vitality Index up to two weeks before discharge. As a follow-up, the life-space assessment was measured three months after discharge. In the statistical analysis, multiple linear and logistic regression analyses were performed with the life-space assessment score and the life-space level of "places outside your town" as dependent variables. [Results] The Falls Efficacy Scale-International, the modified Elderly Mobility Scale, age, and gender were selected as predictors in the multiple linear regression analysis, whereas in the multiple logistic regression analysis, the Falls Efficacy Scale-International, age, and gender were selected as predictors. [Conclusion] Our study emphasized the importance of fall-related self-efficacy and motor function for life-space mobility. The findings of this study suggest that when considering post-discharge living, therapists should conduct an appropriate assessment and adequate planning.

Validity of functional assessment for control of trunk in patients with subacute stroke: a multicenter, cross-sectional study.

[Purpose] The purpose of this study was to clarify the criterion validity, construct validity, and feasibility of the Functional Assessment for Control of Trunk (FACT). [Participants and Methods] This study was a multicenter, cross-sectional study of patients with subacute stroke at three Japanese rehabilitation hospitals. To clarify feasibility, we examined the differences in the measurement time between FACT and the Trunk Impairment Scale (TIS). For the criterion validity of FACT, correlations between FACT, TIS, and the trunk items of the Stroke Impairment Assessment Set (SIAS) were examined using Spearman's rank correlation coefficient. For the construct validity of FACT, we examined the correlations with the other assessments. [Results] Seventy-three patients participated in this study. The measurement time was significantly shorter for FACT (212.6 ± 79.2 s) than TIS (372.4 ± 199.6 s). For criterion validity, FACT correlated significantly with TIS (r=0.896) and two SIAS trunk items (r=0.453, 0.594). For construct validity, significant correlations were found for FACT and other tests (r=0.249-0.797). Areas under the curve for FACT and TIS were 0.809 and 0.812, respectively, and the cutoff values for walking independence were 9 and 13 points, respectively. [Conclusion] For inpatients with stroke, FACT offered feasibility, criterion validity, and construct validity.

Minimal clinically important difference of the Berg Balance Scale and comfortable walking speed in patients with acute stroke: A multicenter, prospective, longitudinal study.

OBJECTIVE: To determine the minimal clinically important difference between the Berg Balance Scale and comfortable walking speed in acute-phase stroke patients. DESIGN: Multicenter, prospective, longitudinal study. SETTING: Inpatient acute stroke rehabilitation. SUBJECTS: Seventy-five patients with acute stroke, mean (SD) age 71.7 (12.2) years. INTERVENTION: Inpatients with acute stroke were assessed with the Berg Balance Scale and comfortable walking speed before and after rehabilitation. Physiotherapy was conducted to improve balance and gait over a 2-week period: an average of 40 min/day on weekdays and 20 min/day on weekends and holidays. MAIN MEASURES: The patients' Berg Balance Scale, comfortable walking speed, Global Rating of Change scale (patient-rated and physiotherapist-rated), and motor score of the Functional Independence Measure were obtained. Minimal clinically important differences were estimated using both anchor- (receiver operating characteristic curves and change difference) and distribution-based approaches (minimal detectable change and 0.5× the change score [SD]). RESULTS: The baseline scores were 31.2 (18.9) for the Berg Balance Scale and 0.79 (0.35) m/s for comfortable walking speed. The minimal clinically important difference in the Berg Balance Scale was 6.5-12.5 points by the anchor-based approach and 2.3-4.9 points by the distribution-based approach. The minimal clinically important difference in comfortable walking speed was 0.18-0.25 m/s by the anchor-based and 0.13-0.15 m/s by the distribution-based approach. CONCLUSIONS: A change of 6.5-12.5 points in the Berg Balance Scale and 0.18-0.25 m/s in the comfortable walking speed is required in these measurements' anchor-based minimal clinically important differences to be beyond measurement error, and to be perceptible by both patients and clinicians.

Relationship between the characteristics of lower extremity function and activities of daily living in hospitalized middle-aged and older adults with subacute cardiovascular disease.

[Purpose] To clarify the relationship between lower extremity function and activities of daily living and characterize lower extremity function in hospitalized middle-aged and older adults with subacute cardiovascular disease. [Participants and Methods] The Short Physical Performance Battery, 6-minute walk distance, and functional independence measure tests were conducted in 79 inpatients with subacute cardiovascular disease (mean age, 76.7 ± 11.9 years; 34 females). Multiple regression analysis used the functional independence measure score as the dependent variable and the Short Physical Performance Battery and 6-minute walk distance scores as independent variables. Cross-tabulations were performed for each age group, and patients who performed the Short Physical Performance Battery and 6-minute walk distance tests were divided into two groups by their respective cutoff values. [Results] Only the Short Physical Performance Battery (ß=0.568) and 6-minute walk distance (ß=0.479) scores were adopted as significant independent variables in each multiple regression model. The age <75 years group had the most patients with both good lower extremity function and aerobic capacity, whereas the age ≥75 years group had the most patients with both functions impaired. [Conclusion] Although cardiovascular disease is generally associated with decreased aerobic capacity, many older patients with cardiovascular disease in this study had decreased lower extremity function, too.

Accuracy of wrist-worn heart rate monitors during physical therapy sessions among hemiparetic inpatients with stroke.

[Purpose] We aimed to examine the accuracy of heart rate monitors worn on the wrist by patients with stroke. The wrist worn heart rate monitor could improve the quality of rehabilitation by monitoring exercise intensity during physical therapy. [Participants and Methods] Thirty inpatients with subacute hemiparetic stroke wore heart rate monitors on both (non-paretic and paretic) wrists, as well as a chest heart rate monitor. We recorded the heart rate values measured at the wrist and chest every minute during physical therapy sessions. The wrist monitors were an optical heart rate measurement device based on photoplethysmography, and the chest monitor was a traditional chest device based on electrocardiography. The relative and absolute reliabilities between the heart rate measurements from the wrist and chest monitors were calculated. [Results] The intraclass correlation coefficients for model 2.1 ranged from 0.75 to 0.79. Bland-Altman analysis revealed a very slight fixed bias; however, no significant proportional bias was observed. For the non-paretic and paretic sides, the lower and upper limits of agreement ranged from -21.8 to 23.8 beats/min and from -20.8 to 21.6 beats/min, and the mean absolute percentage errors were 6.7% and 5.9%, respectively. The Cohen's d value was small. [Conclusion] The relative reliability of the wrist heart rate monitors was substantial. The absolute reliability as bias in wrist heart rate and chest heart rate was small, but heart rates estimated from wrist monitors were not particularly accurate.

Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction.

[Purpose] To compare the sensitivity to change and responsiveness of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in patients with subacute cerebral infarction. [Participants and Methods] Thirty patients with subacute cerebral infarction participated in this study. The Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, Brief-Balance Evaluation Systems Test, Berg Balance Scale, and ambulatory ability were assessed on admission and discharge. Sensitivity to change was calculated using the effect size, standardized response mean, and relative efficiency. Responsiveness was analyzed by comparing the ability of the difference between the scores of the balance assessments at admission and discharge in classifying the participants' ambulatory independence. [Results] All assessments showed significant improvement from admission to discharge. The effect size of the three versions of the Balance Evaluation Systems Test ranged from 0.41 to 0.69. The standardized response mean ranged from 0.75 to 1.28. The cutoff score was 16.7% for the Balance Evaluation Systems Test, 5.5 points for the Mini-Balance Evaluation Systems Test, 1.5 points for the Brief-Balance Evaluation Systems Test, and 3.5 points for the Berg Balance Scale. [Conclusion] The sensitivity to change of the three versions of the Balance Evaluation Systems Test was high or moderate. However, the Mini-Balance Evaluation Systems Test had the highest responsiveness, as determined with the extent of ambulatory independence.

Fall prediction using decision tree analysis in acute care units.

[Purpose] To present an accurate and straight-forward system of fall prediction by performing decision tree analysis using both the fall assessment sheet and Berg balance scale (BBS). [Participants and Methods] The participants in this retrospective study were inpatients from acute care units. We extracted the risk factors for falls from the fall assessment and performed a decision tree analysis using the extracted fall risk factors and BBS score. [Results] "History of more than one fall in the last 1 year", "Muscle weakness", "Use of a walking aid or wheelchair", "Requires assistance for transfer", "Use of Narcotics", "Dangerous behavior", and "High degree of self-reliance" were fall risk factors. The decision tree analysis extracted five fall risk factors, with an area under the curve of 0.7919. Patients with no history of falls and who did not require assistance for transfer or those with a BBS score ≥51 did not fall. [Conclusion] Decision tree-based fall prediction was useful and straightforward and revealed that patients with no history of falling and those who did not require assistance for transfer or had a BBS score ≥51 had a low risk of falling.

Cognitive-motor interference in post-stroke individuals and healthy adults under different cognitive load and task prioritization conditions.

[Purpose] We aimed to compare the effects of cognitive load and task prioritization on dual task strategies in patients with stroke and healthy adults in order to clarify the characteristics of cognitive-motor interference. [Participants and Methods] In total, 26 patients with stroke and 26 age-matched healthy adults (controls) performed the Timed Up and Go Test while performing a serial subtraction task from random numbers between 90 and 100. Dual task was measured under four conditions in which two difficulty levels of "3 subtraction" and "7 subtraction" were multiplied by two prioritizing tasks that involved "paying equal attention to both walking and subtraction tasks" (no priority) and "paying attention while mainly focusing on subtraction tasks" (cognitive priority). [Results] Increasing cognitive load and prioritizing cognitive tasks affected motor performance in terms of the amount of time and number of steps required to complete the Timed Up and Go Test in both the patients and controls. However, cognitive load and task prioritization did not affect cognitive performance. [Conclusion] When cognitive load increases and instructions are given to prioritize increases in cognitive load, patients with stroke use the "posture first" strategy to stabilize their gait as effectively as healthy adults do.

Prediction of falling risk after discharge in ambulatory stroke or history of fracture patients using Balance Evaluation Systems Test (BESTest).

[Purpose] The purpose of this study was to clarify the relationships between falls and sections of the Balance Evaluation Systems Test (BESTest) in patients with stroke or those with a history of fracture. [Subjects and Methods] This longitudinal study included 51 self-ambulatory inpatients. Balance was assessed 1 week prior to discharge using the BESTest, and the incidence of falls within 6 months after discharge was investigated. Relationships between falling and balance components were analyzed using the t-test or the Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis. [Results] Five subjects were dropped out before follow-up at 6 months. Falls were reported by 10 of the remaining 46 participants. Scores for two sections (Anticipatory Postural Adjustments and Sensory Orientation) were significantly lower in fallers than in non-fallers with stroke. Four of the six sections (Biomechanical Constraints, Anticipatory Postural Adjustments, Sensory Orientation, and Stability in Gait) showed areas under the ROC curves >0.8 (0.82, 0.83, 0.84, and 0.81, respectively). In patients with a history of fractures, all sections were not significantly different between fallers and non-fallers. [Conclusion] Anticipatory Postural Adjustments and Sensory Orientation sections of the BESTest were related to future occurrence of fall after discharge in self-ambulatory stroke patients.

Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke.

[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment tool, although it is not confined for use in stroke patients. This study aimed to determine the structural validity of the BESTest in self-ambulatory patients with stroke using both factor and Rasch analyses. [Participants and Methods] This retrospective study included 140 self-ambulatory patients with stroke. The structural validity of the BESTest was analyzed according to principal component, exploratory factor, Rasch, confirmatory factor, and correlation analyses. [Results] The analytical results supported a four-factor model comprising 25 items. The four factors included dynamic postural control with gait, static postural control, stepping reaction, and stability limits in sitting. Evidence of high structural validity and reliable internal consistency suggested that the 25-item BESTest is valid and reliable. Each factor was significantly correlated with lower extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest were poorly correlated, and the remaining 25 items were grouped into four factors that demonstrated good structural validity for patients with stroke. Further studies should validate the applicability of the 25-item BESTest four-factor model in a larger sample of patients with stroke in a clinical setting.

The validity of an accelerometer-based method for estimating fluidity in the sit-to-walk task in a community setting.

[Purpose] Fluidity in the sit-to-walk task has been quantitatively measured with three-dimensional motion analysis system. The purpose of this study was to determine the validity of an accelerometer-based method for estimating fluidity in community-dwelling elderly individuals. [Subjects and Methods] Seventeen community-dwelling elderly females performed a sit-to-walk task. The motion was recorded by an accelerometer, a three-dimensional motion analysis system and a foot pressure sensor simultaneously. The timings of events determined from the acceleration waveform were compared to the timings determined from the three-dimensional motion analysis data (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index from the duration between events. [Results] The characteristics of the acceleration waveform were similar to those previously reported in younger adults. Comparisons of event timings from accelerometer and motion analysis system data indicated no systematic bias. Regression analysis showed that the duration from maximum trunk inclination to the first heel strike was the best predictor of fluidity index. [Conclusion] An accelerometer-based method using the duration between characteristic events may be used to precisely and conveniently assess fluidity in a sit-to-walk task in a community setting.

Effects of high-intensity pulse irradiation with linear polarized near-infrared rays and stretching on muscle tone in patients with cerebrovascular disease: a randomized controlled trial.

[Purpose] The purpose of this study was to clarify the influence of high-intensity pulse irradiation with linear polarized near-infrared rays (HI-LPNR) and stretching on hypertonia in cerebrovascular disease patients. [Subjects and Methods] The subjects were 40 cerebrovascular disease patients with hypertonia of the ankle joint plantar flexor muscle. The subjects were randomly allocated to groups undergoing treatment with HI-LPNR irradiation (HI-LPNR group), stretching (stretching group), HI-LPNR irradiation followed by stretching (combination group), and control group (10 subjects each). In all groups, the passive range of motion of ankle dorsiflexion and passive resistive joint torque of ankle dorsiflexion were measured before and after the specified intervention. [Results] The changes in passive range of motion, significant increase in the stretching and combination groups compared with that in the control group. The changes in passive resistive joint torque, significant decrease in HI-LPNR, stretching, and combination groups compared with that in the control group. [Conclusion] HI-LPNR irradiation and stretching has effect of decrease muscle tone. However, combination of HI-LPNR irradiation and stretching has no multiplier effect.

Development of a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and investigation of its reliability and validity.

[Purpose] To develop a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and quantify its reliability and construct validity. [Subjects] Outpatients with stroke that occurred at least 6 months previously (N = 27) who could walk 10 m without physical assistance were included. [Methods] The CAT-STS was based on the literature and discussion with four physical therapists. The final version of the CAT-STS includes seven items: direction, use of space, foot movement, initiation, termination, instability, and non-fluidity. Patients were videotaped performing a 180-degree turn while standing. The Motricity Index, gait speed and Functional Ambulation Category were also evaluated. Two raters evaluated the turn on two occasions, and inter- and intra-rater reliability were calculated. Construct validity was also calculated. [Results] Inter-rater reliability was fair or moderate for many items (kappa = 0.221-0.746). Intra-rater reliability was good-to-excellent for all items (kappa = 0.681-0.846) except direction and termination. Inter- and intra-rater reliability of the total CAT-STS score were substantial and excellent, respectively (intraclass correlation coefficient = 0.725 and 0.865, respectively). The total CAT-STS score was associated with walking ability and the time and number of steps taken to turn. [Conclusion] The total CAT-STS score is a reliable and valid measure.

Accelerometry-based gait characteristics evaluated using a smartphone and their association with fall risk in people with chronic stroke.

BACKGROUND: The smartphone, which contains inertial sensors, is currently available and affordable device and has the potential to provide a self-assessment tool for health management. The aims of this study were to use a smartphone to record trunk acceleration during walking and to compare accelerometry variables between poststroke subjects with and without a history of falling. METHODS: This cross-sectional study was conducted in 2 day care centers for elderly adults. Twenty-four community-dwelling adults with chronic stroke (mean age, 71.6 ± 9.7 years; mean time since stroke, 68.5 ± 38.7 months) were enrolled. Acceleration of the trunk during walking was recorded in the anteroposterior and mediolateral directions and quantified using the autocorrelation coefficient, harmonic ratio, and interstride variability (coefficient of variation of root mean square acceleration). Fall history in the past 12 months was obtained by self-report. RESULTS: Eleven participants (45.8%) reported at least one fall in the past 12 months and were classified as fallers. Fallers exhibited significantly higher interstride variability of mediolateral trunk acceleration than nonfallers. In the logistic regression analysis, interstride variability of mediolateral trunk acceleration was significantly associated with fall history (adjusted odds ratio, 1.462; 95% confidence interval, 1.009-2.120). The area under the receiver operating characteristic curve for interstride variability of mediolateral trunk acceleration to discriminate fallers from nonfallers was .745 (95% confidence interval, .527-.963). CONCLUSIONS: The results suggest that quantitative gait assessment using a smartphone can provide detailed and objective information about subtle changes in the gait pattern of stroke subjects at risk of falling.

Changes in corticospinal excitability with short-duration high-frequency electrical muscle stimulation: a transcranial magnetic stimulation study.

[Purpose] Afferent input caused by electrical stimulation of a peripheral nerve or a muscle modulates corticospinal excitability. However, a long duration of stimulation is required to induce these effects. The purpose of this study was to investigate the effect of short-duration high-frequency electrical muscle stimulation (EMS) on corticospinal excitability through the measurement of motor evoked potentials (MEP) in young healthy subjects. [Subjects] Eleven healthy right-handed subjects participated in this study. [Methods] EMS was applied to the abductor pollicis brevis (APB) muscle at 100 Hz with a pulse width of 100 µs for 120 s. The intensity of stimulation was just below the motor threshold. Transcranial magnetic stimulation was applied over the motor cortex, and MEP were recorded from the APB before, and immediately, 10, and 20 min after EMS. [Results] In the APB muscle, the MEP amplitude significantly decreased after EMS, and this effect lasted for 20 min. [Conclusion] The excitability of the corticospinal tract decreased after short-duration high-frequency EMS, and the effect lasted for 20 min. These results suggest that even short duration EMS can change the excitability of the corticospinal tract.

Influences of visual and supporting surface conditions on standing postural control and correlation with walking ability in patients with post-stroke hemiplegia.

[Purpose] To quantify the influence of visual and under-foot-surface conditions on standing balance in patients with post stroke hemiplegia and examine associations of this ordinal score with somatosensory disturbance and walking ability. [Subjects] Sixty-six patients with post-stroke hemiplegia. [Methods] Standing balance was tested in 4 conditions (firm floor or foam rubber surface with eyes open or eyes closed) for 30 s per condition and scored using a 5-category ordinal scale. The accuracy of the standing balance score to distinguish patients above/below cut-offs for the timed up-and-go test (14 s) and functional ambulation category (4) was determined. [Results] Standing balance score was correlated with sensory impairments (tactile and vibration perception) and walking ability (up-and-go and functional ambulation category). The standing balance score distinguished patients with up-and-go times ≤14 and >14 s with moderate sensitivity and specificity, and distinguished patients with functional ambulation category <4 and ≥4 with high sensitivity and specificity. [Conclusion] Patients with post-stroke hemiplegia may be unable to adapt to changing visual or surface conditions. Therapists should perform comprehensive balance tests. The standing balance ordinal scale score was moderately correlate with walking ability, distinguishing patients according to walking ability. This scale's validity and reliability must be assessed in clinical settings.

An accelerometer-based method for estimating fluidity in the sit-to-walk task.

[Purpose] The purpose of this study was to clarify the validity of accelerometer data for quantifying fluidity during the sit-to-walk task. [Subjects] The participants were 16 healthy young males. [Methods] The timing of events (task onset, maximum trunk inclination, and first heel strike) was determined from the acceleration waveform and compared to the timing determined from a three-dimensional motion analysis (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index (FI) from the duration between events and the magnitude of the acceleration peak. The task was performed at two speeds (comfortable and maximum). [Results] A comparison of the timings from two different systems indicated no systematic bias. Specific events could be identified from acceleration data using regression analysis under both speed conditions. In addition, significant regression equations predictive of FI were constructed using the duration between events under both speed conditions. The duration from the maximum trunk inclination to the first heel strike was the best predictor of FI. [Conclusion] Accelerometer data may be used to precisely and conveniently evaluate fluidity. The clinical utility of these data should be tested in elderly individuals or patient populations.

The characteristics of multi-directional step distance and the association between stepping laterality and walking ability of patients with stroke.

[Purpose] The purpose of this study was to determine the effect of stepping limb and step direction on step distance and the association of step distance and stepping laterality in step difference with walking ability and motor dysfunction. [Subjects and Methods] The subjects were thirty-nine patients with chronic hemiparesis as a result of stroke, who performed the MSL (Maximum Step Length) test along with tests of motor impairment, gait speed and Functional Ambulation Category. The MSL test is a clinical test of stepping distance in which participants step to the front, side, and back. The subjects were classified into three groups according to the stepping laterality in front step distance. [Results] Step distance did not differ across stepping limbs but did differ across step directions. Front step distance was significantly longer than side and back step distance. Participants with forward paretic step length shorter than forward non-paretic step length had significantly higher walking ability than participants with symmetric forward step length or forward paretic step length longer than forward non-paretic step length [Conclusion] Patients with stroke have characteristic step distances in each direction. Adequate weight shift toward the paretic limb when stepping with the non-paretic limb is associated with walking ability.