Relationship Between Observational Wisconsin Gait Scale, Gait Deviation Index, and Gait Variability Index in Individuals Poststroke

Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19

Background

The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities.

Methods

The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale.

Results

Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001).

Conclusions

Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.

Development of an assessment of bilateral locomotor efficacy for individuals post-stroke

BACKGROUND

A common framework is needed to assess walking impairments in older adults and individuals with stroke. This study develops an Assessment of Bilateral Locomotor Efficacy (ABLE) that is a straightforward indicator of walking function.

RESEARCH QUESTION

Can we develop a clinically accessible index of walking function that summarizes gait dysfunction secondary to stroke?

METHODS

The ABLE index was developed using a retrospective sample of 14 community-dwelling older adults. Data from 33 additional older adults and 105 individuals with chronic post-stroke hemiparesis were used to validate the index by factor analysis of the score components and correlation with multiple common assessments of lower extremity impairment and function.

RESULTS

The ABLE consists of four components summed for a maximum possible score of 12. The components include self-selected walking speed (SSWS), speed change from SSWS to fastest speed, non-paretic leg step length change from SSWS to fastest speed, and peak paretic leg ankle power. The ABLE revealed good concurrent validity with all recorded functional assessments. Factor analysis suggested that the ABLE measures two factors: one for forward progression and another for speed adaptability.

SIGNIFICANCE

The ABLE offers a straightforward, objective measure of walking function in adults, including individuals with chronic stroke. The index may also prove useful as a screening tool for subclinical pathology in community-dwelling older adults, but further testing is required. We encourage utilization of this index and reproduction of findings to adapt and refine the instrument for wider use and eventual clinical application.

Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke

We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.

Spanish Cross-Cultural Adaptation of the Wisconsin Gait Scale

INTRODUCTION

the Wisconsin Gait Scale (WGS) has been shown to be a valid and quick tool for analyzing gait in post-stroke people in the clinical setting. Its widespread use has led to versions of the scale in other languages, but so far there has been no version in Spanish.

OBJECTIVE

to conduct a cross-cultural adaptation of the WGS for use in the Spanish-speaking population and to analyze the content validity.

MATERIALS AND METHODS

the Spanish version was obtained using the double translation method and back translation method, followed by a review by an expert committee. This expert committee evaluated the content validity index (CVI) for each item on the version obtained and for the entire scale (scale content validity index (S-CVI)). The item content validity index (I-CIV) was calculated as the number of experts whose score had been 3 or 4 divided by the total number of experts. To obtain the S-CVI, the middle of the I-CVI was calculated for all the items on the scale.

RESULTS

the Spanish version of the WGS was obtained after the expert committee evaluation. The CVI was excellent for its general assessment (0.91), excellent for 85.7% of its items (≥0.78), and good for 14.3% of the CVI (≥0.72).

CONCLUSIONS

the Spanish version of the WGS was developed through a process of cross-cultural adaptation from its original English version, and, according to an expert committee, it had an excellent content validity.