Abstract
BackgroundGait dysfunction and fatigue are common post-stroke, though it is unclear how extended walking activity, as would be performed during activities of daily living, may change over time. The purpose of this study was to examine if spatial and temporal gait variables deteriorate during an extended bout of walking in a test of functional capacity after stroke.Methods24 community dwelling, independently ambulating individuals greater than 3 months after stroke performed the Six-Minute Walk Test (6MWT). Participants walked over a pressure-sensitive mat on each pass of the 30 m course which recorded spatial and temporal parameters of gait. Mean gait speed and temporal symmetry ratio during each two-minute interval of the 6MWT were examined. Additional post hoc analyses examined the incidence of rests during the 6MWT and changes in gait speed and symmetry.ResultsOn average, participants demonstrated a 3.4 ± 6.5 cm/s decrease in speed over time (p= 0.02). Participants who rested were also characterized by increased asymmetry in the final two minutes (p= 0.05). 30% of participants rested at some point during the test, and if a rest was taken, duration increased in the final two minutes (p= 0.001). Examination of factors which may have been associated with resting indicated that resters had poorer balance (p= 0.006) than non-resting participants.ConclusionThis study supports previous findings establishing that walking performance after stroke declines over relatively short bouts of functionally-relevant ambulation. Such changes may be associated with both cardiorespiratory and muscular fatigue mechanisms that influence performance. The findings also indicate that rest duration should be routinely quantified during the 6MWT after stroke, and consequently, further research is necessary to determine how to interpret 6MWT scores when resting occurs.
Highlights
Gait dysfunction and fatigue are common post-stroke, though it is unclear how extended walking activity, as would be performed during activities of daily living, may change over time
There was a significant change in gait speed over time throughout the 6MWT [F(2, 22) = 4.5, p = 0.02]
Determinants of resting on the 6MWT While our findings indicate that conditions that precipitated resting in these people were associated with increased asymmetry, we cannot determine whether the increasingly asymmetric gait pattern in individuals who rested induced the resting behavior or vice versa
Summary
Gait dysfunction and fatigue are common post-stroke, though it is unclear how extended walking activity, as would be performed during activities of daily living, may change over time. Gait impairments influence functional ambulation – the capacity to perform walking during activities of daily living – and are compounded by low cardiorespiratory fitness in stroke survivors [2,3]. Fatigue is a commonly reported issue after stroke [4,5], and cardiorespiratory and muscular components of fatigue may mutually reinforce one another. Both cardiorespiratory deconditioning and fibre type changes may exacerbate underlying physiological sensorimotor impairments, and compromise the functional performance of activities of daily living – in particular that of gait. The above authors hypothesized that the changes in walking speed reflected the impact of cardiorespiratory challenge and fatigue; it was not possible in either of those studies to determine if sensorimotor control worsened over time and contributed to the decreased performance
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