gms | German Medical Science

Balance and gait performances are key issues and main goals in the rehabilitation of stroke patients. Walking is closely linked to independence in most activities of daily life. The level of walking capacity achieved by patients with stroke in terms of gait velocity, maximal distance covered and endurance is therefore of interest in the rehabilitation process. It is estimated that 60-80 % of patients with stroke achieve walking capacity after their stroke, but of these only 7 % can cover a distance of 500 m at 1.0 m/s. How balance deficits relate to walking performance is not so well understood. The main purpose of this study was to investigate relationships between gait velocity, static and dynamic balance in patients with first time ever stroke in the acute rehabilitation period.

Patients with first ever stroke (n=57) were consecutively included during 2003-04. Mean age was 74 years, (range 38 - 98) and mean time at the stroke unit was 18 days (range 5 -47).

6-minute walk test (6MWT) was the main outcome measure in addition Motor Assessment Scale (MAS) items 3 (sitting balance) and 5 (walking capacity), Bergs Balance Scale (BBS) items 6 (standing eyes closed) and 8 (reaching forward) and Timed Up-and-Go (TUG) was measured on admission to and at discharge from the stroke unit.

6MWT correlated highly to balance measures MAS items 3 and 5, BBS items 6 and 8 and TUG (rs between 0.53 – 0.82) on admission and at discharge (rs between 0.47 – 0.67). Stepwise regression analysis on admission showed TUG (p<0.001), MAS item 3 (p<0.01) and BBS item 8 (p<0.03) to be explanatory factors for gait velocity, with an adjusted R2 0.83. At discharge TUG (p<0.02), MAS item 3 (p<0.001) and BBS item 8 (p<0.001), with an adjusted R2 square 0.73, were the main explanatory factors for gait velocity.

The strong relationships between 6MWT and static balance, measures (MAS item 3 (sitting) and BBS item 6 (standing blindfolded), on admission indicate enhancement of stability at this early stage in stroke patients. The relationships between gait velocity and dynamic balance, MAS item 5 (walking), BBS item 8 (reaching), indicate that dynamic balance, also, is related to gait velocity at this stage. The clinical implication being that balance, both static and dynamic needs to be addressed equally in the early rehabilitation of stroke patients, and is closely related to task, e.g. walking, getting up from a chair, turning, and reaching, and cannot be regarded as separate from the task