Update on an Observational, Clinically Useful Gait Coordination Measure: The Gait Assessment and Intervention Tool (G.A.I.T.).

With discoveries of brain and spinal cord mechanisms that control gait, and disrupt gait coordination after disease or injury, and that respond to motor training for those with neurological disease or injury, there is greater ability to construct more efficacious gait coordination training paradigms. Therefore, it is critical in these contemporary times, to use the most precise, sensitive, homogeneous (i.e., domain-specific), and comprehensive measures available to assess gait coordination, dyscoordination, and changes in response to treatment. Gait coordination is defined as the simultaneous performance of the spatial and temporal components of gait. While kinematic gait measures are considered the gold standard, the equipment and analysis cost and time preclude their use in most clinics. At the same time, observational gait coordination scales can be considered. Two independent groups identified the Gait Assessment and Intervention Tool (G.A.I.T.) as the most suitable scale for both research and clinical practice, compared to other observational gait scales, since it has been proven to be valid, reliable, sensitive to change, homogeneous, and comprehensive. The G.A.I.T. has shown strong reliability, validity, and sensitive precision for those with stroke or multiple sclerosis (MS). The G.A.I.T. has been translated into four languages (English, Spanish, Taiwanese, and Portuguese (translation is complete, but not yet published)), and is in use in at least 10 countries. As a contribution to the field, and in view of the evidence for continued usefulness and international use for the G.A.I.T. measure, we have provided this update, as well as an open access copy of the measure for use in clinical practice and research, as well as directions for administering the G.A.I.T.

Response to upper-limb robotics and functional neuromuscular stimulation following stroke.

Twelve moderately to severely involved chronic stroke survivors (>12 mo) were randomized to one of two treatments: robotics and motor learning (ROB-ML) or functional neuromuscular stimulation and motor learning (FNS-ML). Treatment was 5 h/d, 5 d/wk for 12 wk. ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow (S/E) training. FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation (surface electrodes) for wrist and hand (W/H) flexors/extensors. The primary outcome measure was the functional measure Arm Motor Ability Test (AMAT). Secondary measures were AMAT-S/E and AMAT-W/H, Fugl-Meyer (FM) upper-limb coordination, and the motor control measures of target accuracy (TA) and smoothness of movement (SM). ROB-ML produced significant gains in AMAT, AMAT-S/E, FM upper-limb coordination, TA, and SM. FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination.