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Gait Characteristics and Functional Ambulation Profile in Patients with Chronic Unilateral Stroke

Titianova, Ekaterina B. MD, PhD; Pitkänen, Kauko MD, PhD; Pääkkönen, Ari PhD; Sivenius, Juhani MD, PhD; Tarkka, Ina M. PhD

American Journal of Physical Medicine & Rehabilitation: October 2003 - Volume 82 - Issue 10 - p 778-786
doi: 10.1097/01.PHM.0000087490.74582.E0
CME Article: CM: 2003 Series Number 10: Gait

Titianova EB, Pitkänen K, Pääkkönen A, Sivenius J, Tarkka IM: Gait characteristics and functional ambulation profile in patients with chronic unilateral stroke. Am J Phys Med Rehabil 2003;82:778–786.

Objective Recent technical progress in gait analysis has resulted in portable walkways with embedded pressure-sensitive sensors. Often claims are made in connection with new equipment of their straightforward clinical use. The purpose of the present study was to assess whether the functional ambulation profile (FAP), calculated from walkway data, is a sensitive measure in the characterization of dissimilar patients with chronic hemiparesis due to stroke.

Design We investigated the relationships between FAP and the type of stroke, patients’ functional disability, and spatial and temporal variables of gait obtained with the pressure sensor system walkway. Gait variables and FAP scores were compared in 25 patients with residual hemiparesis due to stroke and in 31 healthy subjects.

Results A prolonged swing phase in the affected side and a prolonged stance phase in the nonaffected side were found in patients. Footprint pressure data revealed reduced peak pressure of the affected-side metatarsal area in patients, probably reflecting foot paresis. Higher Barthel Index score and lower Rankin Scale score were reflected in FAP scores.

Conclusions The FAP scores of patients reflected well their characteristic spatio-temporal gait variations; however, the FAP score seemed a reliable measure of gait normality/abnormality only in rather unhurried gait. Thus, it is useful when a single number is needed.

From the Specialized Hospital of Neurology and Psychiatry St. Naum, Department of Neurology, Medical University, Sofia, Bulgaria (EBT); Brain Research and Rehabilitation Center Neuron, Kuopio, Finland (KP, JS, IMT); and Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland (AP).

Supported, in part, by the Brain Research and Rehabilitation Center Neuron, Kuopio, Finland.

All correspondence and requests for reprints should be addressed to Ina M. Tarkka, PhD, Brain Research and Rehabilitation Center Neuron, Kortejoki, FIN–71130 Kuopio, Finland.

Objectives: On completion of this article, the reader should be able to (1) recognize typically altered characteristics of gait in patients with stroke, (2) associate higher Barthel Index of a stroke patient with higher gait velocity, and (3) distinguish between temporal variables of gait and footprint pressure variables.

Level: Comprehensive.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

The Association of Academic Physiatrists designates this continuing medical education activity for a maximum of 1.5 credit hours in Category 1 of Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he or she actually spent in the education activity.

Disclosure: Disclosure statements have been obtained regarding the authors’ relationships with financial supporters of this activity. There is no apparent conflict of interests related to the context of participation of the authors of this article.

How to Obtain CME Category 1 Credits

To obtain CME Category 1 credit, this educational activity must be completed and postmarked by December 31, 2004. Participants may read the article and take the exam issue by issue or wait to study several issues together. After reading the CME Article in this issue, participants may complete the Self-Assessment Exam by answering the questions on the CME Answering Sheet and the Evaluation pages, which appear later in this section. Send the completed forms to: Bradley R. Johns, Managing Editor, CME Department-AAP, American Journal of Physical Medicine & Rehabilitation, 7240 Fishback Hill Lane, Indianapolic, IN 46278. Documentation can be received at the AAP National Office at any time throughout the year, and accurate records will be maintained for each participant. CME certificates are issued only once a year in January for the total number of credits earned during the prior year.

© 2003 Lippincott Williams & Wilkins, Inc.