Hemiplegic Gait After Stroke: Is Measurement of Maximum Speed Required?

doi:10.1016/j.apmr.2005.11.007

Archives of Physical Medicine and Rehabilitation

Volume 87, Issue 3, March 2006, Pages 358-363

https://doi.org/10.1016/j.apmr.2005.11.007 Get rights and content

Abstract

Kollen B, Kwakkel G, Lindeman E. Hemiplegic gait after stroke: is measurement of maximum speed required?

Objectives

To study the relation between comfortable and maximum walking speed in stroke rehabilitation and to determine which parameters are predictive in this relation and increase the relations’ precision.

Design

One-year prospective cohort study. Longitudinal information was obtained for 10-m comfortable and maximum walking speeds, hemiplegic limb muscle strength, and balance. In addition, subjects’ ages and the type of rehabilitation they received were registered.

Setting

Stroke service facilities.

Participants

Eighty-one acute stroke patients.

Interventions

Not applicable.

Main Outcome Measure

Ten-meter maximum walking speed.

Results

We found a progressive improvement in walking speed and a mean systematic difference between comfortable and maximum walking speeds. An overall mean intraclass correlation coefficient for consistency of ρ equal to .96 and a within- and between-subject regression coefficient of 1.32 were demonstrated for the relation between comfortable and maximum walking speeds. None of the covariables included were statistically significant in the final linear regression prediction model.

Conclusions

Independent of time after onset of stroke, maximum walking speed can be predicted by comfortable walking speed with considerable accuracy. The precision of this estimation is not increased by considering patients’ age, hemiplegic muscle strength, balance, or therapeutic intervention.

Section snippets

Design and Procedures

This prospective cohort study was part of a 3-group RCT conducted to study the effects of augmented exercise training on stroke outcome.²¹ Within 14 days of stroke onset, 101 severely disabled patients with a primary middle cerebral artery stroke were randomly assigned to a basic rehabilitation program that was supplemented with additional arm or leg training, or to a control program in which the arm and leg were immobilized with an inflatable pressure splint. Each treatment regimen was applied

Results

Patient characteristics are presented in table 1. The mean interval ± standard deviation (SD) between stroke onset and first unassisted walk (FAC ≥3) was 4.8±2.9 weeks. None of the patients could walk unassisted in the first week poststroke. Because not all 101 patients progressed to unassisted walking at some point, comfortable walking speed was measured in 85 patients and maximum walking speed in 81 patients. Therefore, our study results were based on a subset population of a maximum of 81

Discussion

Our results show that, in stroke patients with marked hemiplegia, maximum walking speed can be reliably estimated by measuring comfortable walking speed time (in m/s). Cross sectionally and longitudinally applied regression analyses demonstrated that the relation between comfortable and maximum walking speed does not change over time after stroke. We found that maximum speed was 1.32 times that of comfortable speed. Furthermore, this relation remained constant after adding the following

Conclusions

Poststroke maximum walking speed can be estimated with considerable accuracy by multiplying the converted comfortable walking time (in m/s) by approximately 1.3. This relation is stable over time; its precision does not increase when patients’ age, hemiplegic arm or leg muscle strength, balance, or therapeutic intervention are considered and it is independent of time from onset.

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Cited by (54)

Longitudinal changes in trunk acceleration and their relationship with gait parameters in post-stroke hemiplegic patients
2024, Human Movement Science
The purpose of this study was to examine the longitudinal changes in trunk acceleration, gait speed, and paretic leg motion in patients with post-stroke hemiparesis, the relationships between variables at each time point, and whether initial trunk acceleration and gait parameters were related to gait speed 2 months later.
Gait was assessed monthly in patients who could walk under supervision after stroke onset. Gait parameters, including gait speed and trailing limb angle (TLA), were measured. Trunk acceleration was quantified using acceleration root mean square (RMS) and stride regularity (SR) indices.
This study found statistically significant longitudinal changes in gait speed (p < .001), acceleration RMS of the total axes (p < .001), and SR of the vertical axes (p < .001). Gait speed correlated significantly with the acceleration RMS of the mediolateral (r = −0.815 to −0.901), vertical (r = −0.541 to −0.747), and anteroposterior (r = −0.718 to −0.829) axes, as well as the SR of the vertical axes (r = 0.558 to 0.724) at all time points from T0 to T2. For the TLA, only the acceleration RMS of the mediolateral axis correlated significantly over the entire study period (r = −0.530 to −0.724). In addition, initial TLA correlated significantly with gait speed after 2 months (r = −0.572).
This study showed that assessing trunk acceleration helps estimate the improvement in gait status in patients with post-stroke hemiparesis. The magnitude and regularity of trunk acceleration varied longitudinally and were related to gait speed and paretic leg motion at each time point; however, they could not predict future changes in gait speed.
Pathological gait clustering in post-stroke patients using motion capture data
2022, Gait and Posture
Analyzing the complex gait patterns of post-stroke patients with lower limb paralysis is essential for rehabilitation.
Is it feasible to use the full joint-level kinematic features extracted from the motion capture data of patients directly to identify the optimal gait types that ensure high classification performance?
In this study, kinematic features were extracted from 111 gait cycle data on joint angles, and angular velocities of 36 post-stroke patients were collected eight times over six months using a motion capture system. Simultaneous clustering and classification were applied to determine the optimal gait types for reliable classification performance.
In the given dataset, six optimal gait groups were identified, and the clustering and classification performances were denoted by a silhouette coefficient of 0.1447 and $F_{1}$ score of 1.0000, respectively.
There is no distinct clinical classification of post-stroke hemiplegic gaits. However, in contrast to previous studies, more optimal gait types with a high classification performance fully utilizing the kinematic features were identified in this study.
Comfortable and Maximum Gait Speed in Individuals with Chronic Stroke and Community-Dwelling Controls
2021, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Neither were the variables age and time since stroke shown to affect gait speed after stroke. Other factors that have previously been shown to affect gait speed after stroke are muscle strength, cognition, ADL, time-distance-parameters and ambulatory performance.38,56,59 Bijleveld-Uitman et al.60 demonstrated that factors significantly affecting the association between gait speed and community walking were time since the stroke event, standing balance and fear of falling.
The relationship between maximum and comfortable gait speed in individuals with mild to moderate disability in the chronic phase of stroke is unknown.
This study examines the relationship between comfortable and maximum gait speed in individuals with chronic stroke and whether the relationship differ from that seen in a community-dwelling elderly population. Further, we investigate the influence of age, gender, time post-stroke and degree of disability on gait speed.
Gait speed was measured using the 10-meter walk test (10MWT) and the 30-meter walk test (30MWT) in 104 older individuals with chronic stroke and 154 community-dwelling controls, respectively.
We found that the maximum gait speed in individuals with stroke could be estimated by multiplying the comfortable speed by 1.41. This relationship differed significantly from that of the control group, for which the corresponding factor was 1.20. In the stroke group, age, gender and time post-stroke did not affect the relationship, whereas the degree of disability was negatively correlated with maximum speed - but not when included in the multiple analysis. In the community-dwelling population, higher age and female gender had a negative relationship with maximum gait speed. When correcting for those parameters, the coefficient was 1.07.
The maximum gait speed in the chronic phase of stroke can be estimated by multiplying the individual's comfortable gait speed by 1.41. This estimation is not impacted by age, gender, degree of disability and time since stroke. A similar but weaker relationship can be seen in the community-dwelling controls.
Design of a passive lower limb exoskeleton for walking assistance with gravity compensation
2020, Mechanism and Machine Theory
Citation Excerpt :
Simulations by MATLAB/SimMechanics with the methods described in Section 3.1 were performed to assess the influences of these factors. In the simulations, three different gait cycles T = 3 s, 5 s, and 8 s [34] were set with the parameters defined in Tables 2 and 3. The results in the three different cases are shown in Figs. 11 and 12.
In this paper, a passive lower limb exoskeleton with hip and knee joints is proposed for walking assistance. The exoskeleton is designed with built-in spring mechanisms for gravity compensation of the human leg. A pair of mating gears is used to convert the tension force from the built-in springs into balancing torques at the hip and knee joints in order to overcome the influence of gravity. With the novel design, the exoskeleton has a compact layout with small protrusion, which improves its user acceptance and safety. In this paper, the working principle of the design for gravity compensation is described. A model is developed to analyze the effects of the design parameters. Simulations are conducted and the results show that the average absolute driving torque was reduced by 79.0% at the hip joint and 66.4% at the knee joint, with the use of this exoskeleton. Parametric study shows that lower gait speed, lower stiffness with larger pretension of the springs contribute to the maintenance of balance. A prototype of the leg exoskeleton was fabricated, and preliminary tests on healthy subjects verified usability of the exoskeleton.
Stroke rehabilitation: Clinical picture, assessment, and therapeutic challenge
2015, Progress in Brain Research
Citation Excerpt :
When a continuous measure such as gait speed is used, for instance, recovery in walking capacity has been shown to continue in longitudinal studies up to 2 years poststroke (Kollen et al., 2005, 2006b; Richards et al., 2005, 2009) and in numerous intervention studies carried out in persons 6 months or more poststroke (for a review, see Teasell et al., 2012). In a longitudinal study of 101 persons poststroke, Kollen et al. (2006b) reported that none were able to walk unassisted in the first week poststroke and that the first unassisted walk occurred 4.8 ± 2.9 weeks poststroke onset. The mean comfortable walking speed and the mean maximum speed increased from 3.7 to 63.5 cm/s and 7.1 to 85.1 cm/s, respectively, at 1 year poststroke.
This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a person's capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the “best practices” inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.
Strength of the lower limb and trunk muscles is associated with gait speed in individuals with sub-acute stroke: a cross-sectional study
2018, Brazilian Journal of Physical Therapy
Citation Excerpt :
As the evaluation of various muscle groups may assist in the interpretation of the relative importance of each group to gait speed and the non-paretic muscles also show strength impairment,3 bilateral measures of seven lower limb muscle groups were obtained in the present study. Furthermore, maximum gait speed was evaluated in this study as it is an important requirement for the performance of activities in community-based settings and for ensuring individuals’ safety when crossing the street.7,8 Individuals with stroke are classified according to typical phases of spontaneous motor recovery progress.9
To investigate the association between measures of strength of the lower limb and trunk muscles and gait speed and to identify the muscle group that would best predict gait speed in individuals with sub-acute stroke.
Using a cross-sectional observational study design, forty-four individuals with sub-acute stroke (62 years, SD = 14; 4 months, SD = 1 post-stroke) were assessed. The evaluations were performed at a university laboratory, participants’ homes, or community-based settings. Bilateral maximum isometric strength (hip, knee, and ankle flexors/extensors, hip abductors, trunk flexors/extensors, and trunk lateral flexors and rotators) was measured using a portable dynamometer. Comfortable and maximum gait speeds were measured using the 10-m walk test.
Weak to moderate associations were found between measures of strength of the lower limb muscles and comfortable (0.36 ≤ r ≤ 0.53; p < 0.05) and maximum (0.37 ≤ r ≤ 0.59; p < 0.05) gait speeds, except for the non-paretic knee flexors and comfortable gait speed (p = 0.06). Weak to moderate associations were also found between measures of strength of the trunk muscles and comfortable (0.39 ≤ r ≤ 0.50; p < 0.05) and maximum (0.39 ≤ r ≤ 0.61; p < 0.05) gait speeds. Stepwise multiple regression analyses revealed that the non-paretic dorsiflexors and the left lateral trunk flexors explained 29% and 42% of the variance in the maximum and comfortable gait speeds, respectively.
The strength of the lower limb and trunk muscles was positively associated with comfortable and maximum gait speeds. The muscle strength of the non-paretic dorsiflexors and the left lateral trunk flexors might have a role to play in determining comfortable and maximum gait speeds of individuals with sub-acute stroke.

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Supported by the Netherlands Heart Foundation (project no. 93.134) and ZONmw (grant no. 14.350004).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Original articleHemiplegic Gait After Stroke: Is Measurement of Maximum Speed Required?

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measure

Results

Conclusions

Section snippets

Design and Procedures

Results

Discussion

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Lancet

Mobility after strokereliability of measures of impairment and disability

Int Disabil Stud

Measurement in neurological rehabilitation

Clinical gait assessment in the neurologically impairedReliability and meaningfulness

Phys Ther

Functional abilities after strokemeasurement, natural history and prognosis

J Neurol Neurosurg Psychiatry

A prospective trial of serial gait speed as a measure of rehabilitation in the elderly

Age Ageing

A task-orientated intervention enhances walking distance and speed in the first year post strokea randomized controlled trial

Clin Rehabil

The role of technology in task-oriented training in persons with subacute strokea randomized controlled trial

Neurorehabil Neural Repair

Randomized clinical trial of therapeutic exercise in subacute stroke

Stroke

The impact of physical therapy on functional outcomes after strokewhat’s the evidence?

Clin Rehabil

Objective expression of gait improvement of hemiplegics during rehabilitation by time-distance parameters of the stride

Med Biol Eng Comput

Original article
Hemiplegic Gait After Stroke: Is Measurement of Maximum Speed Required?