Clinical Identification for the Use of Light Touch Cues with a Cane in Gait Rehabilitation Poststroke

Abstract

Objectives: To determine clinical characteristics that can be used to identify patients with stroke who can perform light touch contact with a cane during walking, and to determine whether these patients benefit from TC. Methods: A prediction and randomized experimental study was conducted of 62 patients (mean onset time, 43.8 days) who were 59.4 ± 11.2 years. There were 3 conditions of cane usage: force contact (FC), touch contact (TC), and no contact (NC). Clinical characteristics included age, stroke onset duration, gait speed, and Chedoke-McMaster and Fugl-Meyer (FM) Assessment scores. We studied trunk acceleration and activation of tensor fascia latae (TFL), and vastus medialis (VM) muscles during walking using 3 cane conditions. Results: Out of 62 patients, 36 were able to perform TC during walking. These patients benefited from TC as demonstrated by higher trunk stability (compared to NC) and larger paretic VM and TFL activations (compared to FC). FM scale was the only variable that differed between patients who could perform TC and those who could not (P < .00). Analysis of receiver operating characteristics (ROC) revealed that FM scores for balance and lower extremity motor domains (area under ROC = 0.93 and 0.96, respectively) are able to predict the TC group with high accuracy. Calculations using cutoff scores for balance (6.5) or lower extremity (14.5) FM subscales correctly predicted patients who benefited from TC 89% of the time. Conclusion: Balance and lower extremity FM subscales can be used to identify suitable candidates among patients with stroke for implementation of TC in gait rehabilitation.