Impact of a Rehabilitation Program on the Change in Components of Body Mass of the Upper and Lower Limbs in People After Ischemic Stroke.

BACKGROUND The aim of this study was to evaluate the effects of rehabilitation in terms of changes in the body mass composition in the upper and lower limbs depending on the length of time after stroke and the age of the patient. MATERIAL AND METHODS Eighty-two patients after ischemic stroke were tested 3 times: on admission, after 5 weeks, and 3 months after leaving the hospital (follow-up). During each examination, a segmental analysis of the components of the body mass of the upper limbs and lower limbs was performed, depending on the side of paresis. RESULTS Patients between 7 and 12 months after stroke with right-sided paresis had a reduction of fat (P=0.027) and an increase in muscle tissue in the lower (P=0.030) and upper limbs with paresis (P=0.037), as well as in the healthy upper limb (P=0.034) after rehabilitation. Only in the youngest age group (25-44 years) and in patients with left-sided paresis was there a decrease of adipose tissue in the healthy upper (P=0.012) and paresis limbs (P=0.032) and an increase in the muscle tissue mass in the right upper limb (P=0.010) after rehabilitation. CONCLUSIONS The rehabilitation program had a significant impact on the change in the composition of body mass in upper and lower limbs in people with right-sided paresis, particularly 7 to 12 months after stroke and in the youngest age group (25-44 years). These results may be useful in planning a rehabilitation program for stroke patients to consider the patient's dominant hand and neglect.

Effects of Robotic Exoskeleton-Aided Gait Training in the Strength, Body Balance, and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study.

OBJECTIVE: To assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up. DESIGN: Single-group longitudinal preliminary study. SETTING: Individuals with multiple sclerosis (MS) at a hospital neurology ward. PARTICIPANTS: Participants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5. INTERVENTIONS: Exoskeleton-assisted walk training. MAIN OUTCOME MEASURES: Primary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3). RESULTS: At the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant. CONCLUSIONS: Individuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.

Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors.

Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical factors (sex, age, type of stroke and time from the first symptoms) following the rehabilitation process. Materials and Methods: The study group consisted of 100 post-stroke subjects who participated in a comprehensive rehabilitation program for a duration of five weeks. The measurements of body composition by a Tanita MC 780 MA analyser were performed on the day of admission to hospital, on the day of discharge (after 5 weeks) and 12 weeks after discharge from hospital. Results: It was shown that before rehabilitation (Exam I) in the study group there were significant differences in body composition relative to sex, age and time from stroke. The rates of fat mass % and visceral fat level decreased after rehabilitation (Exam II) in both males and females. Exam II, at the end hospital rehabilitation, showed lower levels of fat mass %, visceral fat level, as well as fat-free mass % and higher values of total body water % and muscle mass %. In Exam III, i.e., 12 weeks after discharge, all of the parameters retained their values. Conclusions: The study shows an association between stroke risk factors (primarily age, sex and time from the onset of the first symptoms of stroke) and body mass composition resulting from rehabilitation. The type of stroke and the effects of rehabilitation on body mass components showed no differences. Comprehensive rehabilitation had a positive effect on the body mass components.

Return to work after stroke and related factors in Poland and abroad: A literature review.

BACKGROUND: The incidence of stroke is growing in various parts of the world and the condition most commonly affects the adult population. OBJECTIVES: The purpose of the study is to provide a narrative review of papers published in the last 11 years in English and in Polish and focusing on demographic characteristics of individuals returning to work after stroke, return to work rates, length of time post stroke to return to work as well as health conditions, or personal and environmental factors associated with return to work after stroke. The study also presents the situation regarding return to work after stroke in Poland in comparison to other countries. METHODS: The narrative review covers Polish and foreign literature published between 2007 and 2018. The number of records initially identified through English databases search amounted to 4,912. Five records were additionally identified through other sources (Polish databases). Ultimately 26 (21 foreign, 5 Polish) refereed publications were selected to be reviewed in this study, based on their relevance in terms of specific inclusion/exclusion criteria. RESULTS: The appraisal of Polish and English-language literature shows that stroke survivors' ability to return to work varies; in our country the rate being 43% and outside of Poland reaching the rate of 74.7%. Average time frames for return to work for stroke survivors include from 3 to 6 months, from 12 to 18 months and up to 3 years post stroke. One of the most frequently reported positive factors in the English-language literature is individually tailored vocational rehabilitation. There is a scarcity of studies related to return to work after stroke in Poland. CONCLUSIONS: The findings from studies included in this narrative review may suggest a need to improve the situation in Poland with regard to measures related to return to work after stroke, including vocational rehabilitation which is insufficiently available in Poland.

Analysis of the association between selected factors and outcomes of treadmill gait training with biofeedback in patients with chronic stroke.

OBJECTIVE: To examine the effects of age, time from stroke onset, gender and side of paresis in gait re-education with the use of treadmill with biofeedback, in patients with chronic stroke. METHODS: The study was performed with a group of 50 patients. 10-metre walk test, 2-minute walk test, "Up and Go" test, the number of steps performed with the paretic lower limb at a distance of 10 metres, Barthel index and FIM scale were used to assess the effects of rehabilitation. RESULTS: The study shows that the subjects' abilities and fitness prior to the rehabilitation were not related to age, sex or side of paresis. Analysis of the impact of age, time from stroke and sex on rehabilitation outcomes showed no statistically significant correlations. On the other hand, analysis of rehabilitation results relative to the side of paresis showed that the latter factor significantly differentiates rehabilitation outcomes measured with gait velocity test - p= 0.045. CONCLUSION: Age, duration of time from stroke onset, and sex do not affect outcomes of gait re-education based on treadmill training in patients at a chronic stage post-stroke and Brunnstrom recovery stage 3-4. Side of paresis significantly differentiates rehabilitation outcomes measured with speed test. The best scores in all the performance measures before rehabilitation were identified in the group 3-6 years after stroke.

[An assessment of work ability after the completion of rehabilitation as part of disability pension prevention of the Social Insurance Institution among people with chronic musculoskeletal diseases]. / Ocena zdolnosci do podejmowania pracy po zakonczeniu rehabilitacji w ramach prewencji rentowej Zakladu Ubezpieczen Spolecznych u osób z chorobami przewleklymi narzadu ruchu.

BACKGROUND: The increasing number of people receiving benefits due to incapacity for work is a heavy burden for the state budget. In order to reduce the scale of this phenomenon, the Social Insurance Institution (ZUS) carries out a rehabilitation program as part of disability pension prevention. MATERIAL AND METHODS: The study was based on the analysis of medical documentation of 607 patients rehabilitated at the Saint Queen Jadwiga's Regional Clinical Hospital No. 2 in Rzeszow, as part of the ZUS prevention of disability pension program in 2011-2013. Medical documentation included the medical history and results of the Functional Test recommended by ZUS. Two years after the completion of rehabilitation, a telephone check was conducted among 118 rehabilitated patients to assess their occupational status. RESULTS: The analysis of the Functional Test documentation showed that in all groups of wykorzystujapatients included in the rehabilitation program, as well as those among whom the control was carried out, the majority were people with post-exercise pain, full physical fitness, slight mobility limitation, full efficiency in everyday activities, correct strength of muscles and moving abilities, as well as normal psychosocial efficiency. The vast majority of them received a recommendation regarding work in a properly-adjusted position. It was shown that in the 2-year observation period, the percentage of professionally active people increased from 56% to 61.02%. CONCLUSIONS: The most important factors determining the return to work include psychosocial efficiency and the level of pain. Med Pr. 2019;70(4):459-73.

Association Between Body Mass Index and Results of Rehabilitation in Patients After Stroke: A 3-Month Observational Follow-Up Study.

BACKGROUND We assessed the relationship between body mass index and results of rehabilitation in stroke patients. MATERIAL AND METHODS The study was carried out at the Clinical Rehabilitation Ward with Early Neurological Rehabilitation Unit at the Clinical Hospital. The examinations were performed 3 times. Based on inclusion and exclusion criteria, 128 subjects were qualified for the first examination, the second examination involved 114 subjects, and 100 stroke patients participated in the third examination. Body mass was examined with an accuracy of 0.1 kg, using a Tanita MC-780 MA body composition analyser. Body mass index (BMI) was calculated for all of the subjects. Effects of rehabilitation were assessed with the Barthel index and Ashworth scale. RESULTS Higher functional status in daily life, measured with the Barthel scale, was found in patients with normal body mass, compared to the overweight and obese subjects (examination I, II, and II). Exam I showed that before rehabilitation the overweight patients obtained significantly higher results in assessment of upper limbs, based on the Ashworth scale (mean=0.35±0.54) compared to the obese patients (mean=0.03±0.32) and those with normal body weight (mean=0.24±0.75). CONCLUSIONS Following hospital-based rehabilitation, patients with normal body mass achieved greater functional efficiency. The findings also show a trend towards normalization of BMI. The positive effect of rehabilitation was sustained for 3 months (Exam III), which may contribute to decreased risk of cardiovascular diseases and complications such as stroke.

Diet after Stroke and Its Impact on the Components of Body Mass and Functional Fitness-A 4-Month Observation.

The aim of the study was to assess the effect of various diets on BMI and selected components of body mass, i.e., fat mass (FAT%), visceral fat (VFAT level), muscle mass (PMM %), body water (TBW %), and functional fitness during a 4-month observation period. Examinations were conducted three times in a group of 100 people after a stroke. The study group was divided into four subgroups according to the type of diet applied. The components of body mass were assessed using the electrical bioimpedance method, and functional fitness using the Barthel scale, the Brunnström scale, and the modified Ashworth scale. Despite the fact that there were no significant differences among the diets applied, it was observed that each of them had a positive effect on the reduction of the mean BMI, FAT%, VFAT level, and the increase in TBW% and PMM%. At the same time, there was a significant improvement in the functional fitness of the hand and upper limb. Weight control and a change in eating habits after a stroke incident is extremely important as it promotes faster recovery and improved functional fitness.

Range of motion in the cervical spine after odontoid fracture treated with anterior screw fixation.

BACKGROUND: It is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique. This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients' age. METHODS: The study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation. RESULTS: In the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients' age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001). CONCLUSIONS: Active cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients' age, and intensity of spinal pain.

The Wisconsin gait scale - The minimal clinically important difference.

BACKGROUND: Wisconsin Gait Scale (WGS) is an observational tool for the evaluation of gait quality in individuals after stroke with hemiplegia. It is divided into four subscales, which assess a total of fourteen spatiotemporal and kinematic parameters of gait observed during the consecutive gait phases. However, the WGS score change indicative of important and clinically meaningful change has not been determined. RESEARCH QUESTION: The study has been designed to define the minimal clinically important difference (MCID) of the WGS. METHODS: Four methods were used to determine the MCID for the WGS in 50 participants who had experienced a stroke: anchor-based study, distribution-based study, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. RESULTS: In the anchor-based study, the mean change score in the MCID group was 1.9 points (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 0.3 (the second MCID estimate). The slope of the regression line was 1.21 which means than 1-point change in the Barthel Index (BI) is associated with 1.21-point change in the WGS. This translates to 2.25 points change in the WGS with 1.85 points change in the BI (the third MCID estimate). The best cut-off point, determined with ROC curve, was the value corresponding to 1 point of change in the WGS (the fourth MCID estimate). SIGNIFICANCE: We established that the MCID of the WGS was 2.25 points, based on the largest of the four MCID estimates. The value 2.25 of the MCID can help clinicians and researchers determine if the change in the scores on the WGS is clinically important. CLINICAL TRIAL REGISTRATION: Data are parts of the following clinical trial: ACTRN12617000436370.

Validity of the gait variability index for individuals after a stroke in a chronic stage of recovery.

BACKGROUND: Increased variability in spatiotemporal variables has been demonstrated in individuals after stroke. Gait Variability Index (GVI) has recently been proposed, potentially to be used as a standardized tool for quantifying gait impairment due to spatiotemporal variables. The experience with the GVI in patients after stroke is unknown. RESEARCH QUESTION: The aim of this study was to investigate the validity of the GVI as an outcome measure of gait disturbance after stroke. METHODS: 50 individuals (mean age 60.9 ± 11.2 years) after stroke at a chronic phase of recovery were included. The control group comprised 50 healthy subjects without gait disorders, matched for age and gender. Data on functional mobility and spatiotemporal gait parameters (BTS Smart system) was collected. RESULTS: The results showed lower mean GVI (mGVI) scores (mean 78.53 ± 6.12), lower GVI for the affected leg (mean 76.32 ± 7.98) and for the unaffected leg (mean 80.74 ± 4.68) in the individuals after stroke compared to the healthy subjects (mean 98.00 ± 6.32). This was significantly different from the control group mean for both mGVI, affected and unaffected leg - p < 0.001. The GVI for the affected leg and unaffected leg as well as the mGVI were significantly correlated with all clinical measures of functional mobility (0.7≤R|<0.9, 0.5≤|R|<0.7, p < 0.001). SIGNIFICANCE: The validity of the GVI appears to be confirmed for individuals after stroke at a chronic stage of recovery. The GVI is lower in individuals after stroke compared to healthy controls. The GVI showed moderate to strong correlations with validated clinical measures of functional mobility. Application of the GVI in the clinical practice will significantly facilitate assessment of gait in individuals after stroke, in comparison to the necessity to interpret a large number of data from 3-dimensional gait analysis. CLINICAL TRIAL REGISTRATION: Data are parts of the following clinical trial: ACTRN12617000436370 (anzctr.org.au).

The use of the Gait Variability Index for the evaluation of individuals after a stroke.

PURPOSE: The Gait Variability Index (GVI) summarizes overall gait quality, taking into account spatiotemporal parameters from a 3-dimensional gait analysis. However, there are no studies evaluating changes in gait patterns after stroke, based on the GVI. The study was designed to assess usefulness of the GVI for evaluation of gait pathology in subjects with stroke, compared to healthy individuals. METHODS: Spatiotemporal gait parameters were examined in a group of 50 subjects at a chronic stage post-stroke and in 50 healthy controls. The GVI was calculated based on the 9 spatiotemporal data. RESULTS: The findings show statistically significant differences between the values of the GVI for paretic and non-paretic limbs ( p < 0.001). Higher values of the index were identified in the case of non-paretic limb: 80.74 vs. 76.32. The GVI scores were decreased for both paretic and non-paretic limbs, compared to the controls - p < 0.001. CONCLUSIONS: The GDI score seems to be a viable tool for quantifying changes in gait pattern during evaluation of subjects with chronic post-stroke hemiparesis. Further studies should be conducted to validate the use of GVI in the post-stroke population.

The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study.

BACKGROUND: In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy. METHODS: The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined. RESULTS: The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman's rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists. CONCLUSIONS: The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters. TRIAL REGISTRATION: anzctr.org.au , ID: ACTRN12617000436370 . Registered 24 March 2017.

The Efficacy of Gait Training Using a Body Weight Support Treadmill and Visual Biofeedback in Patients with Subacute Stroke: A Randomized Controlled Trial.

BACKGROUND: This study was designed to determine whether or not gait training based on the use of treadmill with visual biofeedback and body weight support (BWS) would produce better effects in patients with subacute stroke compared to BWS treadmill training with no visual biofeedback. MATERIALS AND METHODS: 30 patients with subacute stroke were randomly assigned to do body weight supported treadmill training with visual biofeedback (BB group) or BWS treadmill training without visual biofeedback. Their gait was assessed with a 3D system (spatiotemporal gait parameters and symmetry index) and by means of 2-minute walk test (2 MWT), 10-metre walk test (10 MWT), and Timed Up & Go test. Subjects in both groups participated in 15 treadmill training sessions (30 minutes each). RESULTS: The participants from both groups achieved a statistically significant improvement in spatiotemporal gait parameters, walking speed, endurance, and mobility. The average change in the BB group after the end of the programme did not differ significantly compared to the change in the control group. The change in the symmetry index value of stance phase in the BB group was 0.03 (0.02) and in the control group was 0.02 (0.02). The difference was not statistically significant (p = 0.902). The statistically significantly higher improvement in the BB group was found in the range of walking speed (p = 0.003) and endurance (p = 0.012), but the difference between groups was of low clinical significance. CONCLUSIONS: The findings do not confirm that BWS treadmill training with the function of visual biofeedback leads to significantly greater improvement in gait compared to BWS treadmill training with no visual biofeedback at an early stage after stroke. This study was registered at ClinicalTrials.gov, ID: ACTRN12616001283460.

Posture control in patients with herniated nucleus pulposus in cervical and lumbosacral spine subjected to operative treatment.

BACKGROUND: Patients with lumbar degenerative disc disease suffer from impairments in deep trunk muscles, which may lead to poorer posture control. OBJECTIVE: The purpose of the study was to assess body balance during double limb stance in patients with herniated nucleus pulposus in cervical and lumbosacral spine, subjected to surgical treatment. METHODS: The qualified subjects included patients operated due to herniated nucleus pulposus in lumbosacral (L-S group) and in cervical area (C group) as well as healthy controls. Static balance was examined in double-limb stance, with eyes open and closed, on force platform. The patients were examined before the surgery, on the day they were discharged from the hospital ward and one month following the discharge from the ward. RESULTS: The findings show significant differences between the study group and the controls in the examined parameters before and after the surgery. It was observed significant differences in the length of centre of pressure path in the trial with eyes closed between the L-S and C groups. CONCLUSIONS: Both groups of patients with discopathy have significantly poorer posture control in comparison to healthy subjects. After operative treatment both groups of patients with discopathy presented with significantly decreased values in all the examined balance parameters.

Assessment of cervical range of motion in patients after axis fracture.

BACKGROUND: Surgical treatment of odontoid fractures with posterior C1/C2 fusion always leads to severe limitations in mobility of the cervical spine and head. PURPOSE: To assess the mobility of the cervical spine in patients treated with various surgical methods after an axis body fracture. MATERIAL AND METHODS: A group of 61 subjects receiving surgical treatment in a group of 214 subjects treated for odontoid fractures at one ward of neurosurgery at a regional hospital. Studies also included odontoid peg and Hangman fractures. The range of motion of the head was compared to standards by the International Standard Orthopedic Measurements (ISOM) and to head mobility in a control group of 80 healthy subjects without any pathologies or complaints associated with the cervical spine. Ranges of motion were measured with the CROM goniometre with regard to flexion, extension, right and left lateral flexion and right and left rotation. The functional status was evaluated with Neck Disability Index (NDI) standard questionnaires indicated for patients with cervical spine pain. RESULTS: Except for flexion and extension, patients after odontoid fractures had a statistically significantly smaller range of motion of the cervical spine in all planes compared to the control group and ISOM standards. CONCLUSIONS: Odontoid fractures lead to limitations in mobility of the cervical spine even after treatment with methods that in theory should preserve the C1/C2 mobility.

An assessment of the relationship between the items of the observational Wisconsin Gait Scale and the 3-dimensional spatiotemporal and kinematic parameters in post-stroke gait.

BACKGROUND: There are few reports in the literature investigating the relationship between observational gait scales used to assess individuals after a stroke and objective data acquired from 3-dimensional gait analysis (3DGA). RESEARCH QUESTION: The objective of this study was to compare the relationship between the specific items of the Wisconsin Gait Scale (WGS) and the matching 3-dimensional (3D) spatiotemporal and kinematic gait parameters in individuals after a stroke. In this way we evaluated whether using the simple, inexpensive, easy-to-use, observational WGS can fully substitute for the very costly and time-consuming 3DGA. METHODS: The study group comprised 50 participants who had experienced a stroke and were in the chronic stage of recovery. The study participants' gait was evaluated by means of the WGS; spatiotemporal and kinematic gait parameters were examined in the Gait Laboratory with the use of the BTS Smart system. The 3D recording of gait was performed using 2 video cameras positioned in such a way that it was possible to obtain images in the frontal and the sagittal plane. RESULTS: The findings show strong (0.7 ≤ |R| < 0.9; p < 0.001) or very strong (0.9≤ |R| < 1; p < 0.001) correlation between the specific items of the WGS and the matching 3D gait parameters. SIGNIFICANCE: The WGS is a diagnostic tool useful for conducting observational gait analysis in people with post-stroke hemiparesis and in situations when the costly objective methods of gait assessment cannot be applied for various reasons, the scale may be an effective tool enabling the assessment of gait. The WGS may be particularly useful in the subacute period of stroke as video recording of walking takes considerably less time than 3DGA. The study has been registered at the ClinicalTrials.gov, ID: ACTRN12617000436370.

Relationships between walking velocity and distance and the symmetry of temporospatial parameters in chronic post-stroke subjects.

PURPOSE: Subjects with post-stroke hemiparesis frequently present with asymmetric gait patterns. Symmetry, reflecting similarities in temporospatial, kinematic parameters, is an important measure of gait assessment. The study was designed to examine the relationships between asymmetry of temporal, spatial and kinematic gait parameters and walking velocity and distance. METHODS: Temporospatial and kinematic gait parameters were examined in a group of 50 chronic post-stroke subjects and in a group of 25 healthy controls. Symmetry ratio was calculated for all the parameters. Gait velocity was measured during 10-metre test, the walking distance during 2-Minute Walk Test, and balance during Up and Go Test. RESULTS: The relationship between stance phase duration symmetry and gait speed was at a moderate level (r = -0.43, p = 0.0173). There was a moderate relationship between swing phase symmetry and walking velocity and distance. The findings did not show a significant correlation between step length symmetry versus gait speed and distance. CONCLUSIONS: There is a mild relationship between self-selected gait velocity and walking distance versus temporal parameters symmetry. The findings do not confirm a relationship between self-selected gait velocity and walking distance versus spatial and kinematic parameters as well as balance. Likewise, no evidence confirms that asymmetry of temporal, spatial, kinematic gait parameters changes with the age of post-stroke subjects or is related to the length of time from stroke onset. Given the above, gait symmetry may be recognized as an important indicator of the level of gait control in post-stroke patients because it enables unique gait assessment, independent from other parameters.

Analysis of consistency between temporospatial gait parameters and gait assessment with the use of Wisconsin Gait Scale in post-stroke patients.

INTRODUCTION: Due to the increasing incidence and social effects of stroke there is a growing interest in finding methods enabling gait analysis in this group of patients. Observational techniques are predominantly applied in clinical practice; on the other hand advanced quantitative methods allow in-depth multidimensional gait assessment. The present study was designed to assess the consistency between temporospatial gait parameters acquired through 3-dimensional gait analysis and the results of gait assessment with the use of observational WGS in post stroke hemiparetic patients. MATERIAL AND METHOD: The study was performed in a group of 30 post-stroke patients, over 6 months from the onset of ischaemic stroke, who were able to walk unassisted. Gait assessment based on WGS was performed by an experienced physiotherapist, with the use of video recordings. Assessment of temporospatial parameters was based on gait analysis performed with BTS Smart system. RESULTS: The findings show moderate correlation between WGS based gait assessment and gait velocity (r=-0.39; p=0.0316). Similar relationship was identified between gait cycle duration and score in WGS for both unaffected (r=-0.36; p=0.0477) and affected side (r=-0.37; p=0.0426). Higher correlation level was demonstrated for stance phase on the unaffected side and gait assessment based on WGS (r=0.58; p=0.0009). CONCLUSIONS: Gait assessments with the use of temporospatial parameters and with observational WGS were found to produce moderate and good consistent results. WSG is a useful, simple tool for assessing gait in post stroke hemiparetic patients.

Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up From a Randomized Controlled Trial.

BACKGROUND One of the most significant challenges for patients who survive a stroke is relearning basic motor tasks such as walking. The goal of this study was to evaluate whether training on a treadmill with visual biofeedback improves gait symmetry, as well as spatiotemporal and kinematic gait parameters, in stroke patients. MATERIAL AND METHODS Thirty patients in the chronic phase after a stroke were randomly allocated into groups with a rehabilitation program of treadmill training with or without visual biofeedback. The training program lasted 10 days. Spatiotemporal and kinematic gait parameters were evaluated. For all parameters analyzed, a symmetrical index was calculated. Follow-up studies were performed 6 months after completion of the program. RESULTS The symmetrical index had significantly normalized in terms of the step length (p=0.006), stance phase time, and inter-limb ratio in the intervention group. After 6 months, the improvement in the symmetry of the step length had been maintained. In the control group, no statistically significant change was observed in any of the parameters tested. There was no significant difference between the intervention group and the control group on completion of the program or at 6 months following the completion of the program. CONCLUSIONS Training on a treadmill has a significant effect on the improvement of spatiotemporal parameters and symmetry of gait in patients with chronic stroke. In the group with the treadmill training using visual biofeedback, no significantly greater improvement was observed.