Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke

The objective of this study was to identify the most important clinical var iables determining gait speed in persons with stroke. Sixteen chronic strok e subjects (mean age, 47.9 (+/-15.6) yr; mean time post-stroke, 43.9 (+/-36 .5) mo) able to walk independently without a brace participated in the stud y. The impairments in motor function, sensation of the paretic lower limb, and balance were evaluated with the Fugl-Meyer Assessment. A spasticity ind ex was used to assess the muscle tone of the plantarflexors. The maximal st rengths in plantarflexion and hip flexion were measured with a Biodex dynam ometric system. Cinematography and foot-contact data collected on the paret ic side were used to determine the comfortable and maximal gait speeds. The level of association between gait speeds and the clinical variables were f irst examined with Pearson's correlation coefficients and, then, with multi ple linear regression analyses using the stepwise method. Results revealed that the motor function of the lower limb, balance, and hip flexion strengt h were significantly related to comfortable and maximal gait speeds (0.5 < r < 0.88; P < 0.05). For the comfortable gait speed, the regression analysi s selected only the hip flexor strength as a significant variable (R-2 = 0. 69). For maximal gait speed, the variables retained were hip flexor strengt h, sensation at the lower limb, and plantarflexor strength (R-2 = 0.85). Th e present results suggest that strength and sensation at the lower limb are important factors to consider in determining the gait capacity of chronic stroke subjects.