A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke surviveors

Background: Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. Methods: Stroke survivors (n = 42) stepped to targets, on a 6 m walkway, placed to elicit step lengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missed during six walks and target stepping speed was recorded. Fugl-Meyer (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. Results: Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM (F-(1,F-40) = 6.54, p = 0.014,). Speed of target stepping was a significant predictor of each of BBS (F((1,40)) = 26.36, p < 0.0001), SSWS (F-(1,F-40) = 37.00, p < 0.0001). No variables were significant predictors of SL or SS asymmetry. Discussion: Speed of target stepping was significantly predictive of BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors. (C) 2015 Elsevier B.V. All rights reserved.