ASSESSING FACTORS IMPACTING COMMUNITY AMBULATION AFTER STROKE

Abstract

Purpose/Hypothesis: Limited community ambulation is a common occurrence following stroke and is associated with limited participation in activities of daily living. The skills and factors affecting community ambulation following stroke are largely unknown. This study measured participation in community mobility among survivors of stroke and examined the relationship between clinical measures of sensation, strength, balance, and gait and participation in community mobility in order to identify factors constraining community ambulation following stroke. Number of Subjects: Twenty-five adults diagnosed with stroke (mean age 68 ± 9; mean time since stroke 40 mos, independent ambulators with devices) and 25 older adults (mean age 68 ± 11) without stroke participated. Materials/Methods: Level of participation in community ambulation was determined by self reported number of trips and walking related activities performed over a 12 day period (72 hour recall trip activity log completed once a week for four weeks). Clinical measures included the Berg Balance Test (BBT), 10m gait velocity, and Dynamic Mobility Evaluation (DYME) (a new measure of locomotor adaptation), dynamometer measures of lower extremity (LE) strength, goniometric measures of LE range of motion, ankle spasticity, and LE sensation (light touch and proprioception). Results: Participation in community mobility following stroke was characterized by equivalent number of trips into the community, but fewer walking related activities per trip, as compared to adults without stroke. Gait velocity and BBT were significantly (p<.001) worse in the subjects with stroke, and correlated with number of walking related activities (r=.508, p<.01) but not number of trips into the community. Compared to healthy controls, subjects with stroke walked significantly slower on all complex walking tasks in the DYME, however there was considerable variability across tasks. Some tasks (stairs and obstacles) consistently affected gait velocity in all subjects with stroke, while others (load and talk) did not. Impairments in plantarflexion and hip abduction strength in the paretic limb correlated with community ambulation (activities per trip), while spasticity, range of motion and lower extremity sensation were not. Conclusions: This study suggests the impact of stroke on community ambulation is variable. Clinical measures of balance, strength (plantarflexor and hip abduction) and gait velocity are related to level of participation in community ambulation, specifically the number of walking activities performed per trip. Performance of complex walking tasks requiring locomotor adaptation was globally impacted by stroke, but the degree of impact varied by task. Clinical Relevance: Recovery of community ambulation is influenced by many factors following stroke, including balance, strength and usual gait speed. Task specific training to improve the ability to adapt gait to environmental challenges encountered during community ambulation may be a particularly important aspect of mobility training following stroke.