Gabriela M Rozanski1, Jennifer S Wong1, Elizabeth L Inness1,2, Kara K Patterson1,2,3, Avril Mansfield1,2,4. 1. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. 2. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. 3. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. 4. Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
Abstract
Purpose: To describe the change in spatiotemporal gait asymmetry after discharge from stroke rehabilitation and examine the relationship with change in other clinical outcome measures. Methods: Secondary analysis of a prospective cohort study was conducted. Swing time and step length symmetry, balance, mobility, gait speed, and motor impairment were assessed at discharge and 6 months later. Participants (n = 61) were classified by shift in symmetry status (Asymmetric-to-Symmetric, Symmetric-to-Asymmetric, No Shift) and magnitude of difference scores (Improved, Worse, No Difference). Correlations between change in spatiotemporal symmetry and the other clinical measures of physical status were calculated. Results: At discharge, 61% (37/61) and 36% (22/61) of participants were asymmetric in swing time and step length, respectively. Of this subgroup, 43% (16/37) and 50% (11/22) shifted to symmetric gait by follow-up. In contrast, only six individuals significantly improved in swing and/or step symmetry according to minimal detectable change. Change in spatiotemporal symmetry was not significantly correlated with change in the clinical outcome measures.Conclusions: Despite overall gains in physical function and decreased prevalence of asymmetry, most individuals with stroke do not improve in swing or step symmetry following discharge from rehabilitation. Further research is necessary to elucidate factors that affect recovery of gait quality.Implications for rehabilitationAsymmetric gait after stroke is a major concern for patients and their therapists but can be resistant to intervention.Spatiotemporal asymmetry persists for many individuals following discharge from hospital stay despite improvement in other gait-related measures.While the determinants of change remain unclear, gait quality should be specifically monitored and addressed to avoid long-term negative effects.
Purpose: To describe the change in spatiotemporal gait asymmetry after discharge from stroke rehabilitation and examine the relationship with change in other clinical outcome measures. Methods: Secondary analysis of a prospective cohort study was conducted. Swing time and step length symmetry, balance, mobility, gait speed, and motor impairment were assessed at discharge and 6 months later. Participants (n = 61) were classified by shift in symmetry status (Asymmetric-to-Symmetric, Symmetric-to-Asymmetric, No Shift) and magnitude of difference scores (Improved, Worse, No Difference). Correlations between change in spatiotemporal symmetry and the other clinical measures of physical status were calculated. Results: At discharge, 61% (37/61) and 36% (22/61) of participants were asymmetric in swing time and step length, respectively. Of this subgroup, 43% (16/37) and 50% (11/22) shifted to symmetric gait by follow-up. In contrast, only six individuals significantly improved in swing and/or step symmetry according to minimal detectable change. Change in spatiotemporal symmetry was not significantly correlated with change in the clinical outcome measures.Conclusions: Despite overall gains in physical function and decreased prevalence of asymmetry, most individuals with stroke do not improve in swing or step symmetry following discharge from rehabilitation. Further research is necessary to elucidate factors that affect recovery of gait quality.Implications for rehabilitationAsymmetric gait after stroke is a major concern for patients and their therapists but can be resistant to intervention.Spatiotemporal asymmetry persists for many individuals following discharge from hospital stay despite improvement in other gait-related measures.While the determinants of change remain unclear, gait quality should be specifically monitored and addressed to avoid long-term negative effects.
Authors: Kristen A Pickett; Nancy Schultz-Darken; Abigail F Bradfield; Kerri Malicki; Bruce Pape; Karla K Ausderau; Marina E Emborg Journal: J Neurosci Methods Date: 2019-11-12 Impact factor: 2.390