Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study.

BACKGROUND: Early prognosis, adequate goal setting, and referral are important for stroke management. OBJECTIVE: To investigate if independent gait 6 months poststroke can be accurately predicted within the first 72 hours poststroke, based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to check whether accuracy changed over time. METHODS: In 154 first-ever ischemic stroke patients unable to walk independently, 19 demographic and clinical variables were assessed within 72 hours and again on days 5 and 9 poststroke. Multivariable logistic modeling was applied to identify early prognostic factors for regaining independent gait, defined as ≥4 points on the Functional Ambulation Categories. RESULTS: Multivariable modeling showed that patients with an independent sitting balance (Trunk Control Test-sitting; 30 seconds) and strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for all 3 items, or movement against resistance but weaker for 1 item) on day 2 poststroke had a 98% probability of achieving independent gait at 6 months. Absence of these features in the first 72 hours was associated with a probability of 27%, declining to 10% by day 9. CONCLUSIONS: Accurate prediction of independent gait performance can be made soon after stroke, using 2 simple bedside tests: "sitting balance" and "strength of the hemiparetic leg." This knowledge is useful for making early clinical decisions regarding treatment goals and discharge planning at hospital stroke units.

The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders.

OBJECTIVE: To investigate the intra-rater and inter-rater reliability of the Erasmus MC modifications to the Nottingham Sensory Assessment (EmNSA). SUBJECTS: A consecutive sample of 18 inpatients, with a mean age of 57.7 years, diagnosed with an intracranial disorder and referred for physiotherapy. SETTING: The inpatient neurology and neurosurgery wards of a university hospital. DESIGN: Through discussions between four experienced neurophysiotherapists, the testing procedures of the revised Nottingham Sensory Assessment were further standardized. Subsequently, the intra-rater and inter-rater reliabilities of the EmNSA were investigated. RESULTS: The intra-rater reliability of the tactile sensations, sharp blunt discrimination and the proprioception items of the EmNSA were generally good to excellent for both raters with a range of weighted kappa coefficients between 0.58 and 1.00. Likewise the inter-rater reliabilities of these items were predominantly good to excellent with a range of weighted kappa coefficients between 0.46 and 1.00. An exception was the two-point discrimination that had a poor to good reliability, with the range for intra-rater reliability of 0.11-0.63 and for inter-rater reliability -0.10-0.66. CONCLUSION: The EmNSA is a reliable screening tool to evaluate primary somatosensory impairments in neurological and neurosurgical inpatients with intracranial disorders. Further research is necessary to consolidate these results and establish the validity and responsiveness of the Erasmus MC modifications to the NSA.