Gait disorders in subacute stroke: Meta-analysis and case series

Abstract

Gait disorders are one of the first complaints after a stroke. No specific classification of these gait disorders has been proposed in the literature. Furthermore, few epidemiological data are available, including speed and walking abilities in acute and subacute stages. To determine the walking speed and prevalence of acute and subacute gait disorders after stroke. To propose a classification of gait disorders, and analyze the link between motor and cognitive impairments, walking abilities and patient outcomes. A meta-analysis was performed, selecting hospital based-studies reporting walking speed after a first stroke. Then, we evaluated the walking abilities of patients in a neurovascular unit. The severity of the stroke was evaluated using the National Institute of Health Stroke Scale (NIHSS), cognitive functions with the Mini-Mental State Examination (MMSE), autonomy using Modified Rankin Scale (Rkm), and gait autonomy with the Functional Ambulation Categories (FAC). In addition, a classification of gait disorders was established for the study. Prevalence of gait disorders in acute and subacute stroke was 63.6%, with an average walking speed of 0.34 m/s. Walking abilities depends on initial stroke severity, location of ischemic stroke, and patient's outcome ( P = 0001). Walking speed was associated with cognitive functions ( P = 0.01), as well as walking abilities ( P = 0.001). Gait disorders are frequent in acute and subacute post-stroke stages, with a decrease in walking speed > 70%. Walking abilities depends on the initial severity of the stroke, and are predictive of patients’ outcome. In addition, walking and cognitive functions seem to be linked after stroke, demonstrating cognitive-motor interference. Eventually, the classification proposed in this study will allow a better management of post-stroke gait disorders and rehabilitation.