CLASSIFICATION OF WALKING HANDICAP IN THE STROKE POPULATION

Background and Purpose The limited walking ability that follows a stro ke restricts the patient's independent mobility about the home and com munity, a significant social handicap. To improve the in-hospital pred iction of functional outcome, the relationships between impairment, di sability, and handicap were assessed with clinical measures in 147 str oke patients. Methods The patients' level of functional walking abilit y at home and in the community was assigned by expert clinicians to on e of the six categories of a modified Hoffer Functional Ambulation sca le at least 3 months after discharge. A 19-item a questionnaire was fu rther used to assess current customary mobility of the subjects. Funct ional muscle strength and proprioception were tested, and walking velo city was measured. Results The significant indicators of impairment, u pright motor control knee flexion and extension strength, differentiat ed household from community ambulators. The addition of velocity impro ved the functional prediction. Proprioception was clinically normal in all walkers. The validity of the criteria for the six levels of walki ng handicap was confirmed statistically. Stepwise discriminant analysi s reduced the ambulation activities on the questionnaire from 19 to 7. Redefinition of the criteria for patient classification using the coe fficients and constants of the seven critical functions improved the p rediction of patient walking ability to 84%. Conclusions The results o f this study offer a quantitative method of relating the social disadv antage of stroke patients to the impairment and disability sustained. The measurement of therapeutic outcome in relation to the social advan tage for the patient would allow more efficient standardization of tre atment and services.