Clinical gait and balance scale (GABS): validation and utilization.

Gait and Balance Scale (GABS) consists of historical information and examination of 14 different gait and balance parameters designed to assess the severity of these functional domains. Thirty-five patients with Parkinson's disease (PD), Hoehn and Yahr stages 1-3, were tested during their "off" period. GABS items were compared to quantitative data from two computerized gait analysis instruments, GAITRite and Pro Balance Master. Intra-class correlation coefficients were calculated to establish reliability. Intra-rater test-retest reliability was determined using Cohen's Kappa statistic. Concurrent validity was derived using the Spearman's rho test with the items from GABS, GAITRite and Balance Master. Intra-rater reliability was high with k>0.41 (k=kappa statistic) for 17 items, 6 had k>0.61. When performing validity measurements, a number of items on the GABS had a correlation coefficient significant at p<0.01 (2-tailed). Posture, pull test, balance during stance, single limb stance, tandem stance, turning, toe walking and functional reach had significant correlation with Balance Master data (R=0.46-1). Gait, arm swing, gait speed, steps/5 m, 'up-and-go test', modified performance oriented assessment of gait scale and provocative testing had significant correlation with the GAITRite items (R=0.51-0.83). GABS is an easy-to-use comprehensive clinical scale with high intra-rater and internal item reliability. We have shown concurrent validity with two computerized gait analysis instruments. We expect GABS to have a particular utility in clinical trials designed to modify functional impairment associated with abnormalities in gait and balance.

Reliability of measures of gait performance and oxygen consumption with stroke survivors.

This study assessed the reliability of gait performance with concurrent measures of oxygen consumption (VO2) in stroke survivors (SS). Nine male SS (60.00 +/- 15.08 yr) had a recent history of stroke (44.56 +/- 51.35 days since the stroke) and were receiving rehabilitation. Four had a right cerebrovascular accident (CVA), and five had a left CVA. Subjects walked without assistance, although three used a single cane to complete the test. Within 30 minutes, subjects completed two trials of a 5 min walk while walking back and forth on a 5 m walkway wearing a portable gas analyzer to collect samples of gases. The intraclass correlation coefficient (ICC) was used to assess reliability. The ICC for gait energy expenditure, walk distance, gait speed, and gait energy cost were 0.64, 0.97, 0.95, and 0.97, respectively. Assessment of gait performance with concurrent measures of VO2 is a reliable procedure with SS.

The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia.

OBJECTIVE: To determine the effect of altering the foot placement of the dominant limb in young healthy subjects and the uninvolved limb of subjects with hemiplegia on their ability to perform sit to stand (STS). DESIGN: Controlled biomechanical experiment. SETTING: Research laboratory of a university health science center. PARTICIPANTS: Nonrandom convenience sample of 10 healthy and 10 subjects with hemiplegia. Respective mean ages were 26 and 59 years. All patients with hemiplegia could ambulate and STS independently. The mean time since the stroke was 3.6 years. INTERVENTIONS: Subjects came from a sitting to a standing position under 3 different conditions: (1) normal condition, where both limbs were placed in 100 degrees of knee flexion; (2) limb extended condition, where the dominant or uninvolved limb was extended to 75 degrees of knee flexion; and (3) limb elevated condition, where the dominant or uninvolved limb was placed on a dense foam support equal to 25% of the subject's knee height. MAIN OUTCOME MEASURES: Vertical and anteroposterior ground reaction forces (GRFs) and bilateral tibialis anterior and quadriceps electromyogram (EMG) activity. RESULTS: In the young subjects, the normally placed nondominant limb compensated for the extended or elevated position of the dominant limb. Peak GRFs and EMG amplitudes were all significantly greater for the nondominant limb. In patients with hemiplegia, the EMG of the involved limb increased 39% in the limb-elevated and -extended conditions compared with the normal condition. Respective values for the uninvolved limb decreased. GRFs were significantly greater for the uninvolved limb except for the vertical force in the limb-extended position. CONCLUSIONS: Muscle activity and GRFs can be influenced by altering the initial foot placement of the dominant or uninvolved limb during STS. These initial data have positive implications for the rehabilitation of patients with hemiplegia who could be taught to overcome a reduced ability to use their impaired limb after stroke.