DEFICIT AND CHANGE IN GAIT VELOCITY DURING REHABILITATION AFTER STROKE

Objective: To quantify the initial deficit, changer and outcome in gai t velocity during inpatient rehabilitation following stroke. Design: T he initial deficit on admission to rehabilitation was quantified by co mparing 42 stroke patients with 42 controls matched by gender and age, The change in the stroke patients during the next 8 weeks was quantif ied and gait outcome was compared with functional and normal criteria. Setting: Patients were referred from four inpatient rehabilitation ce nters at tbe time of admission following a median of 16.5 days in the acute hospital. Patients: Selection criteria: ability to give informed consent; unilateral first stroke; ability to walk 10 meters. Interven tion: Patients participated in a median of 17.38 hours of individual p hysical therapy including a median of 6.92 hours of gait training duri ng the 8 weeks. Main Outcome Measure: Gait velocity. Results: Gall vel ocity was initially 38.6% (26.7m/min SD = 14.9) of the performance of controls and improved to 55.1% (38.1m/min). At outcome only 24% exceed ed the 5th percentile of controls (48.1m/min) or the velocity required to cross the typical signalled intersection (46.2m/min). The change w as only 26% of the initial deficit. Fifty-live percent of the patients improved beyond the 95% confidence intervals surrounding the error of measuring change. Indices of responsiveness indicated that there was a high signal-to-noise ratio and a robust effect size. Conclusion: Gai t velocity discriminated the effect of stroke and tilt: change during rehabilitation. (C) 1996 by the American Congress of Rehabilitation Me dicine and the American Academy of Physical Medicine and Rehabilitatio n