Published Online
on November 10, 2005

A more recent version of this article appeared on December 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/12/2676    most recent 01.STR.0000190839.29234.50v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kollen, B. Articles by Kwakkel, G. Search for Related Content PubMed PubMed Citation Articles by Kollen, B. Articles by Kwakkel, G. Related Collections Exercise/exercise testing/rehabilitation Acute Cerebral Infarction Rehabilitation, Stroke

Submitted on July 19, 2005
Accepted on September 8, 2005

Predicting Improvement in Gait After Stroke. A Longitudinal Prospective Study

Boudewijn Kollen; Ingrid van de Port MS; Eline Lindeman MD, PhD; Jos Twisk PhD; and Gert Kwakkel PhD^*

From the Research Bureau (B.K.), Isala klinieken, Zwolle, The Netherlands; Rehabilitation Centre "De Hoogstraat", Rudolf Magnus Institute of Neuroscience, UMC Utrecht (I.v.d.P., E.L., G.K.), The Netherlands; and EMGO Institute/Department of KEB (J.T.), VU Medical Centre, Amsterdam, The Netherlands.

^* To whom correspondence should be addressed. E-mail: g.kwakkel{at}vumc.nl..

Background and Purpose--To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability.

Methods--A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population. Prospective cohort study based on 18 repeated measurements over time during the first poststroke year. Baseline characteristics as well as longitudinal information from functional ambulation categories (FAC), Fugl-Meyer leg score (FM-leg), Motricity index leg score (MI-leg), letter cancellation task (LCT), Fugl-Meyer balance (FM-balance), and timed balance test (TBT) were obtained. Intervention consisted of a basic rehabilitation program with additional arm, leg, or air splint therapy. Main outcome measure constituted change scores on FAC over time.

Results--In total, 1532 of the 1717 change scores were available for regression analysis. The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC (=0.094; P<0.001) followed by changes scores on FM-leg (=0.014; P<0.001) and reduction in LCT omissions (=-0.010; P<0.001) and MI leg test (=0.001; P<0.001). In addition, time itself was significantly negatively associated with improvement (=-0.002; P<0.001).

Conclusion--Improvement in standing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability, whereas reduction in visuospatial inattention is independently related to improvement of gait. Finally, time itself is an independent covariate that is negatively associated with change on FAC, suggesting that most pronounced improvements occur earlier after stroke.

Key words: cerebrovascular accident • gait • longitudinal studies • prognosis • recovery of function

This article has been cited by other articles:

				I. J. W. van Nes, M. E. van Kessel, F. Schils, L. Fasotti, A. C. H. Geurts, and G. Kwakkel Is Visuospatial Hemineglect Longitudinally Associated with Postural Imbalance in the Postacute Phase of Stroke? Neurorehabil Neural Repair, October 1, 2009; 23(8): 819 - 824. [Abstract] [PDF]

				S. S. Y. Au-Yeung, C. W. Y. Hui-Chan, and J. C. S. Tang Short-form Tai Chi Improves Standing Balance of People With Chronic Stroke Neurorehabil Neural Repair, June 1, 2009; 23(5): 515 - 522. [Abstract] [PDF]

				B. J. Kollen, S. Lennon, B. Lyons, L. Wheatley-Smith, M. Scheper, J. H. Buurke, J. Halfens, A. C.H. Geurts, and G. Kwakkel The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? Stroke, April 1, 2009; 40(4): e89 - e97. [Abstract] [Full Text] [PDF]

				L. D. Alexander, S. E. Black, K. K. Patterson, F. Gao, C. J. Danells, and W. E. McIlroy Association Between Gait Asymmetry and Brain Lesion Location in Stroke Patients Stroke, February 1, 2009; 40(2): 537 - 544. [Abstract] [Full Text] [PDF]

				J. H. Buurke, A. V. Nene, G. Kwakkel, V. Erren-Wolters, M. J. IJzerman, and H. J. Hermens Recovery of Gait After Stroke: What Changes? Neurorehabil Neural Repair, November 1, 2008; 22(6): 676 - 683. [Abstract] [PDF]

				S. F. Tyson, M. Hanley, J. Chillala, A. B. Selley, and R. C. Tallis The Relationship Between Balance, Disability, and Recovery After Stroke: Predictive Validity of the Brunel Balance Assessment Neurorehabil Neural Repair, July 1, 2007; 21(4): 341 - 346. [Abstract] [PDF]

				K. Hashimoto, K. Higuchi, Y. Nakayama, and M. Abo Ability for Basic Movement as an Early Predictor of Functioning Related to Activities of Daily Living in Stroke Patients Neurorehabil Neural Repair, July 1, 2007; 21(4): 353 - 357. [Abstract] [PDF]

				G. Kwakkel, B. Kollen, and J. Twisk Impact of Time on Improvement of Outcome After Stroke Stroke, September 1, 2006; 37(9): 2348 - 2353. [Abstract] [Full Text] [PDF]

				B. Kollen, G. Kwakkel, and E. Lindeman Time Dependency of Walking Classification in Stroke Physical Therapy, May 1, 2006; 86(5): 618 - 625. [Abstract] [Full Text] [PDF]