Mapping Trajectories of Gait Recovery in Clinical Stroke Rehabilitation

Abstract

Background: How gait changes during the early stages of stoke rehabilitation, and which patient characteristics are associated with these changes is still largely unknown. Objective: he first objective was to describe the changes in gait during stroke rehabilitation. Secondly, we determined how various patient characteristics were associated with the rate of change of gait over time. Methods: Participants were measured every 3 weeks during stroke rehabilitation. The assessment consisted of an inertial measurement unit (IMU) based 2-minute walk test (2MWT), 3 IMU-based balance tests, and standard clinical tests. In the 2MWT, participants were equipped with 3 IMUs, from which speed, variability, asymmetry, and smoothness were calculated. The changes in gait were examined from admission to discharge at an individual level. The effect of patient characteristics on the rate of change of the gait features over time was assessed with growth models. Results: A total of 81 Trajectories from 72 participants were analyzed. On an individual basis, speed increased in 32 trajectories. Only a few trajectories exhibited significant changes in variability, asymmetry, and smoothness over the clinical rehabilitation period. The growth models revealed a significant increase in speed and decrease in variability and smoothness. Only the Berg Balance Scale and gait speed at onset were (negatively) associated with the rates of change of speed and smoothness, respectively. Conclusion: We found a substantial variability in the gait-feature outcomes and their progression in individuals after stroke during clinical rehabilitation. The patient characteristics studied had limited associations with the rate of change of gait features over time.