Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial.

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

Concurrent validity and reliability of a low-cost gait analysis system for assessment of spatiotemporal gait parameters.

OBJECTIVE: To determine the concurrent validity and reliability of a low-cost spatiotemporal gait analysis system for clinical use in rehabilitation medicine. DESIGN: Cross-sectional study. SUBJECTS: Thirty-three healthy adults. METHODS: The spatiotemporal gait analysis system consists of a video camera placed perpendicular to a 10-m walkway and calibrated for spatial reference. The conditions evaluated in this study were: barefoot walking at comfortable and slow speed, toe and shod walking using a stationary camera setup and barefoot walking at comfortable speed using a moving camera setup. The GAITRite® was used as reference. RESULTS: High intraclass correlation coefficients (ICC≥ 0.97; 95% lower limit confidence intervals (95% CIs) ≥ 0.77) were found between systems for step and stride length, and step, stance and stride time, across setups and conditions. Standard error of measurement and Bland-Altman repeatability coefficients were ≤ 2.4% and ≤ 6.3%, respectively. A minimum of 4 footsteps was required to obtain ICC >0.90 and coefficient of variation < 10%. For double support and swing time, ICCs were generally low (ICC≥ 0.21). Inter-rater reliability was excellent for step length, step and stance time (ICC≥ 0.94; lower limit 95% CIs ≥ 0.86). CONCLUSION: The spatiotemporal gait analysis system is valid and reliable for assessing spatiotemporal parameters in different walking conditions. However, the validity of double support and swing time could not be confirmed.

Validity and reproducibility of the Functional Gait Assessment in persons after stroke.

OBJECTIVE:: To evaluate construct validity and reproducibility of the Functional Gait Assessment (FGA) for measuring walking balance capacity in persons after stroke. DESIGN:: Cross-sectional study. SETTING:: Inpatient and outpatient rehabilitation center. SUBJECTS:: Fifty-two persons post-stroke (median (25% and 75% percentiles)) time post-stroke 6 (5-10) weeks) with independent walking ability (mean gait speed 1.1 ± .4 m/s). METHODS:: Subjects completed a standardized FGA twice within one to eight days by the same investigator. Validity was evaluated by testing hypotheses on the association with two timed walking tests, Berg Balance Scale, and the mobility domain of the Stroke Impact Scale using correlation coefficients ( r), and with Functional Ambulation Categories using the Kruskal-Wallis test. Reproducibility of FGA scores was assessed with intraclass correlation coefficient and standard error of measurement. RESULTS:: Subjects scored a median of 22 out of 30 points at the first FGA. Moderate to high significant correlations ( r .61-.83) and significant differences in FGA median scores between the Functional Ambulation Categories were found. Eight hypotheses (80%) could be confirmed. Inter-rater, intra-rater, and test-retest reliability of the total scores were excellent. The standard error of measurement and minimal detectable change were 2 and 6 points, respectively. No relevant ceiling effect was observed. CONCLUSION:: The FGA demonstrated good measurement properties in persons after stroke and yielded no ceiling effect in contrast to other capacity measures. In clinical practice, a measurement error of 6 points should be taken into account in interpreting changes in walking balance.

Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial.

BACKGROUND: Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly limited to the orthotic effects of peroneal functional electrical stimulation in the chronic phase after stroke. The aim of this study is to investigate the therapeutic effects of up to 10 weeks of multi-channel functional electrical stimulation (MFES)-assisted gait training on the restoration of spatiotemporal gait symmetry and walking capacity in subacute stroke patients. METHODS: In a proof-of-principle study with a randomised controlled design, 40 adult patients with walking deficits who are admitted for inpatient rehabilitation within 31 days since the onset of stroke are randomised to either MFES-assisted gait training or conventional gait training. Gait training is delivered in 30-minute sessions each workday for up to 10 weeks. The step length symmetry ratio is the primary outcome. Blinded assessors conduct outcome assessments at baseline, every 2 weeks during the intervention period, immediately post intervention and at 3-month follow-up. DISCUSSION: This study aims to provide preliminary evidence for the feasibility and effectiveness of MFES-assisted gait rehabilitation early after stroke. Results will inform the design of a larger multi-centre trial. TRIAL REGISTRATION: This trial is registered at the Netherlands Trial Register (number NTR4762 , registered 28 August 2014).

Walking tests for stroke survivors: a systematic review of their measurement properties.

PURPOSE: To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD: Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS: Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS: Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.

The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke?

OBJECTIVE: To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke. DESIGN: Clinimetric study. SETTING: Three rehabilitation centers in the Netherlands. PARTICIPANTS: A sample of patients after stroke (N=75; mean age ± SD, 58.8±9.8y) who are capable of walking without physical assistance. Patients were excluded if they had sustained a subarachnoid hemorrhage or a stroke in the cerebellum or brainstem, or had any other conditions that limited their walking capacity more than the current stroke, or had sensory aphasia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Construct validity (6-minute walk test [6MWT]) and test-retest reliability of the SWT were assessed. Measurement error was determined with the standard error of measurement (SEM), limits of agreement, and smallest detectable differences (SDDs). RESULTS: Construct validity was confirmed by high significant correlations (r(p)≥.65, P<.01) between the SWT and 6MWT. Difference scores were significantly higher in favor of the SWT for high-speed walkers (≥0.8m/s). In the small group (n=12) of low-speed walkers (<0.8m/s), no significant correlations and differences between both tests were found except for walking distance in favor of the 6MWT. Test-retest reliability was good (intraclass correlation coefficient model 2,1 [ICC(2,1)]=.961 [.936-.977]). SEM was 6.0%, and the SDDs for individual and group were 302.0m (37%) and 38.7m (5%), respectively. CONCLUSIONS: The SWT is a valid and reliable measure and therefore a feasible instrument to determine functional walking capacity of patients after stroke, especially in high-speed walkers.