RESUMEN
Objectives: In stroke patients, the assessment of gait ability over time is important. For quantitative gait assessment using measuring devices, the walking speed condition for measurement is generally based on the patient's preferred walking speed or the maximum walking speed at the time of measurement. However, because walking speed often increases during the convalescent stage, understanding the effects of change in walking speed on gait when comparing the course of recovery is necessary. Although several previous studies have reported the effects of change in walking speed on gait in stroke patients, the time-distance parameters described in these reports may not be generalizable because of the small case numbers. Therefore, we measured treadmill gait at the preferred walking speed (PWS) and 1.3 times the PWS (130% PWS) in 43 post-stroke hemiplegic patients and analyzed the effects of change in walking speed on time-distance parameters. Methods: Forty-three patients with hemiplegia after a first stroke, who were able to walk on a treadmill under supervision, were recruited as subjects. Using a three-dimensional motion analysis system, treadmill gait was assessed under two conditions: PWS and 130% PWS. The primary outcome measures were the time-distance parameters, which were compared between the PWS and 130% PWS conditions. Results: Cadence, stride length, and step length of the affected and unaffected lower limbs increased significantly at 130% PWS compared with at PWS. In terms of actual time, single stance time and initial and terminal double stance time in both affected and unaffected limbs decreased significantly at 130% PWS. In terms of relative time (% of the gait cycle), compared with PWS, relative single stance time increased significantly, whereas relative initial and terminal double stance times decreased significantly at 130% PWS in both the affected and unaffected limbs. Conclusions: This study on treadmill gait in patients with hemiplegia after a first stroke confirmed the effects of change in walking speed on time-distance parameters. Our results will help in the interpretation of time-distance parameters measured under different walking speed conditions.
RESUMEN
Tomida K, Tanino G, Sonoda S, Hirano S, Itoh N, Saitoh E, Kagaya H, Suzuki A, Kawakami K, Miyajima T, Takai M. Development of Gait Ability Assessment for hemiplegics (GAA) and verification of inter-rater reliability and validity. Jpn J Compr Rehabil Sci 2021; 12: 19-26. Objective: To develop the Gait Ability Assessment for hemiplegics (GAA), and to verify its validity and inter-rater reliability. Methods: We developed the GAA, a new method for the assessment of gait ability. Next, we examined the inter-rater reliability of GAA by assessing gait ability of post-stroke patients by two physical therapists. Then, we verified the validity of GAA by comparing with the existing assessments methods comprising Functional Ambulation Categories (FAC), Functional Independence Measure (FIM)-walk, maximum walking speed, motor subscore of the FIM (FIM-M), and total score of affected-side motor function of the Stroke Impairment Assessment Set (SIAS-L/E). Results: Regarding the inter-rater reliability of GAA, κ coefficient was 0.76 and weighted κ coefficient was 0.96. The correlation coefficients between GAA scores and existing assessment methods were: 0.95 for FAC scores, 0.95 for FIM-walk scores, 0.82 for maximum walking speed, 0.89 for FIM-M, and 0.61 for SIAS-L/E, all of which showed a significant correlation (p<0.01). Conclusion: GAA has high inter-rater reliability as well as high validity as a gait ability assessment method, suggesting that it can be applied to research and clinical settings.
