Published online before print February 28, 2008, doi: 10.1161/STROKEAHA.107.508085
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(Stroke. 2008;39:e76.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
Response to Letter by Lord and Rochester
Indiana University, School of Health and Rehabilitation Sciences, Department of Occupational Therapy, Stroke QUERI, and HSRD Center of Excellence on Implementation of Evidence Based Practices, Richard L. Roudebush, VAMC at Indianapolis, Indiana
Division of Physical Therapy, Duke University, School of Medicine, Durham, NC
University of Pittsburgh and GRECC, Department of Medicine, Geriatrics, VA Pittsburgh Healthcare System, Pittsburgh, Pa
Department of Veteran Affairs Gainesville Florida, University of Florida, College of Public Health and Health Profession, Department of Occupational Therapy, Gainesville, Fla
Response:
We thank Drs Lord and Rochester for their interest and comments regarding our study results. We agree that gait velocity and gait itself are complex in nature with many variables contributing to gait velocity classifications and community ambulation. Richards et al previously reported that poststroke self-selected gait velocity are reliable and valid measures of functional walking status.1 We used the classifications which Perry et al2 introduced to assist in classifying gait velocity, and used the domains of the Stroke Impact Scale3 to associate change in gait velocity with change in community ambulation. However, we did not intend to suggest that gait velocity is the sole determinant of community ambulation, but that it can serve as a simple yet valid measure of community ambulation.
In 2005, Drs Lord and Rochester indicated a need to further study self-report of gait and to further advance the development of a theoretical framework for measuring community ambulation.4 Gait velocity is likely part of that framework and should not be ignored. Community ambulation is certainly affected by other factors including cognition, depression, and fear of falling.5–9 Gait velocity is thus one of many important and measurable factors related to enhanced community ambulation; our work was intended to provide evidence that increases in gait velocity thresholds can provide useful guidelines to stroke survivors, clinicians, and caregivers and can be related to enhanced community ambulation.
Acknowledgments
Disclosures
None.
References
1. Richards CL, Malouin F, Wood-Dauphinee S. Gait velocity as an outcome measure of locomotor recovery after stroke. In: Craik RA, Oatis C, eds. Gait Analysis: Theory and Applications. St Louis, Mo: Mosby; 1995: 355–364.
2. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995; 26: 982–989.
3. Lai SM, Perera S, Duncan PW, Bode R. Physical and social functioning after stroke: comparison of the Stroke Impact Scale and Short Form-36. Stroke. 2003; 34: 488–493.
4. Lord SE, Rochester L. Measurement of community ambulation after stroke: current status and future developments. Stroke. 2005; 36: 1457–1461.
5. Hama S, Hidehisa Y, Shigenobu M, Watanabe A, Hiramoto K, Kurisu K, Yamawaki S, Kitaoka T. Depression or apathy and functional recovery after stroke. International Journal of Geriatric Psychiatry. 2007; 22: 1046–1051.[CrossRef][Medline] [Order article via Infotrieve]
6. Friedman PJ, Baskett JJ, Richmond DE. Cognitive impairment and its relationship to gait rehabilitation in the elderly. N Z Med J. 1989; 102: 603–606.[Medline] [Order article via Infotrieve]
7. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990; 45: 239–243.
8. Hauer K, Pfisterer M, Weber C, Wezler N, Kliegel M, Oster P. Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls. Journal of the Am Geriatrics Society. 2003; 51: 1638–1644.[CrossRef]
9. Hyndman D, Ashburn A. "Stops walking when talking" as a predictor of falls in people with stroke living in the community. J Neurol Neurosurg Psychiatry. 2004; 75: 994–997.
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