Interrater and intrarater reliability and minimal detectable change of the Wisconsin Gait Scale when used to examine videotaped gait in individuals post-stroke

Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial

BACKGROUND

Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.

METHODS

An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.

RESULTS

A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively).

CONCLUSIONS

The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.

TRIAL REGISTRATION

This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.

Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review

There is a growing awareness of the significance of using minimum clinically important differences (MCIDs) in stroke research. An MCID is the smallest change in an outcome measure that is considered clinically meaningful. This review is the first to provide a comprehensive summary of various scales and patient-reported outcome measures (PROMs) used in stroke research and their MCID values reported in the literature, including a concise overview of the concept of and methods for determining MCIDs in stroke research. Despite the controversies and limitations surrounding the estimation of MCIDs, their importance in modern clinical trials cannot be overstated. Anchor-based and distribution-based methods are recommended for estimating MCIDs, with patient self-evaluation being a crucial component in capturing the patient's perspective on their health. A combination of methods can provide a more comprehensive understanding of the clinical relevance of treatment effects, and incorporating the patient's perspective can enhance the care of stroke patients.

The development and reliability testing of the Functional Lower-Limb Amputee Gait Assessment

OBJECTIVE

The study purpose was three-fold: (a) to describe the development of the Functional Lower-Limb Amputee Gait Assessment, (b) to determine its reliability with two groups of raters, physical therapists, and certified prosthetists, and (c) to determine the agreement on its results between the two groups.

DESIGN

A reliability study.

SETTING

Institution for higher education.

PARTICIPANTS

Five physical therapists and five certified prosthetists.

INTERVENTION

Not applicable.

MAIN MEASURE

The gait of people with unilateral lower limb amputation was evaluated using the Functional Lower-Limb Amputee Gait Assessment. Kappa statistic was used to analyze reliability.

RESULTS

The intra-rater reliability of nine gait deviations in the physical therapists' group and eight in the certified prosthetists' group was between moderate and almost perfect agreement (kappa = .41-1). In the physical therapists' group, the inter-rater reliability of four gait deviations was moderate (kappa = .41-.6). In the certified prosthetists' group, the inter-rater reliability of six gait deviations was moderate to substantial (kappa = .41-.8). Three gait deviations achieved moderate agreement in both groups of clinicians (kappa = .41-.6).

CONCLUSIONS

Most gait deviations included in the Functional Lower-Limb Amputee Gait Assessment appear stable over time when used by the same clinician. Six gait deviations in the certified prosthetists' group and four in the physical therapists' group may be used by multiple clinicians, and three gait deviations may be used across both professions to assist in communication and collaboration on the best course of treatment for a patient with a unilateral lower limb amputation.

Inter- and intra-rater reliability of new application software for computerised paediatric version of Wisconsin Gait Scale

The paediatric version of Wisconsin Gait Scale (WGS) is a reliable tool for gait assessment in children with spastic hemiplegic cerebral palsy (CP). We decided to develop a solution which will make it possible to objectify the descriptive paediatric version of the WGS, and which, consequently, will allow researchers/clinicians to more easily perform accurate assessment of gait patterns in patients. The aim of the study was to assess inter- and intra-rater reliability of new application software for computerised paediatric version of the WGS in children with hemiplegic CP. The study involved 31 children with hemiplegic CP. The app was designed using a model based on thematic categories of the paediatric WGS, and utilising auxiliary lines between specific points on the patient's body, and taking into account angular values, duration and length of the specific gait phases, in order to enable acquisition of quantitative data corresponding to the components of the WGS. The gait of the study participants was recorded, in series of videos. These provided material for three independent raters who reviewed the recordings twice and assessed the participants' gait using the app. After the evaluation was completed, the data were retrieved from the software. The new application software for the computerised paediatric WGS presents very good inter- and intra-rater reliability. Intra-class correlation coefficient (ICC) was very high in measurement 1 (ICC > 0.9) and 2 (ICC > 0.8), which reflects a very high degree of agreement between the three examiners; there was also high agreement for the specific examiners, between the two measurements (ICC > 0.9). The observational gait scale, objectified through the new software, and enabling computer-aided use of the paediatric WGS, presents practical advantages for examiners since it facilitates decisions taken in the process of WGS-based assessment in children with spastic hemiplegic CP.

Effectiveness of the Pelvic Clock and Static Bicycle Exercises on Wisconsin Gait Scale and Trunk Impairment Scale in Chronic Ambulatory Hemiplegic Patients: A Single Group Pre-Post Design

BACKGROUND

Most Hemiplegic patients achieve ambulatory function during the sub-acute stage of stroke. Though ambulatory, they still perform an unpleasant awkward gait with remarkable compensations requiring more energy expenditure. Fatigue arises at an early duration as a result of increased energy expenditure. The walking pattern becomes circumduction, featured by asymmetry with an extensor synergy of the lower limb. Each step is rotated away from the body then towards the body, forming a semicircle. This leads to changes in various parameters of gait (spatiotemporal, kinematic, and kinetic) in hemiparetic patients.

PURPOSE

Many studies reveal the effectiveness of various therapeutic techniques in managing hemiplegic circumduction gait. Pelvic clock exercises aid in improving pelvic rotation components and cause dissociation in impaired pelvic mobility due to spasticity. A static bicycle helps in enhancing proper control between the hamstrings and quadriceps. It also helps in improving knee flexion range. As the patient places the foot in the cycle's petals, it helps to enhance dorsiflexion and eversion functions as well. As the lower body is exercised, there could be relative changes in the upper body, i.e., the trunk. Thus, this study aimed to determine the changes in gait functions and trunk performance of chronic ambulatory hemiplegic patients in response to the above therapies for four weeks.

METHOD

Twenty-five subjects (post-stroke duration (2.8 ± 0.6) years) who could walk 10 m independently without assistance or support of aid participated in a pelvic clock and static bicycle exercise intervention. The session duration was 30 min a day, and therapy was delivered six days a week and continued for four weeks. The entire program was carried out in an outpatient neurorehabilitation center.

RESULTS

After the intervention with pelvic clock and static bicycle exercises, there was a remarkable change in gait and trunk functions in chronic hemiplegic patients.

CONCLUSION

The exercises comprising pelvic clock and static bicycle showed positive differences in gait and trunk functions in chronic stage hemiplegic patients. Later, randomized controlled studies involving larger sample sizes, advanced activation techniques, and increased intervention duration will explore in-depth information on their effectiveness and clinical significance.

Distracted mobile device use among street-crossing college student pedestrians: an observational approach

ObjectiveTo estimate the incidence of mobile device use among street-crossing pedestrians and explore differences by sex and intersection type at a large public South-eastern university in the United States.ParticipantsAll instances of campus pedestrians crossing the street during the observation period (N = 4,878).MethodsVideo recordings of crosswalk activity at four locations were analyzed for pedestrian use of a mobile device while crossing.ResultsDevice use while crossing was observed 1,201 (24.6%) times. Of male crossing instances, 277 (16.8%) were coded as using a device. Of female instances, 924 (28.6%) were coded as using a device. Differences in device use while crossing were found between sexes and some intersection types.ConclusionsThis study estimates mobile device use while crossing the street and suggests differences by sex and intersection type. Future research should focus on improving understanding of the problem and evaluation of interventions to address the issue.

Three decades of gait index development: A comparative review of clinical and research gait indices

BACKGROUND

A wide variety of indices have been developed to quantify gait performance markers and associate them with their respective pathologies. Indices scores have enabled better decisions regarding patient treatments and allowed for optimized monitoring of the evolution of their condition. The extensive range of human gait indices presented over the last 30 years is evaluated and summarized in this narrative literature review exploring their application in clinical and research environments.

METHODS

The analysis will explore historical and modern gait indices, focusing on the clinical efficacy with respect to their proposed pathology, age range, and associated parameter limits. Features, methods, and clinically acceptable errors are discussed while simultaneously assessing indices advantages and disadvantages. This review analyses all indices published between 1994 and February 2021 identified using the Medline, PubMed, ScienceDirect, CINAHL, EMBASE, and Google Scholar databases.

FINDINGS

A total of 30 indices were identified as noteworthy for clinical and research purposes and another 137 works were included for discussion. The indices were divided in three major groups: observational (13), instrumented (16) and hybrid (1). The instrumented indices were further sub-divided in six groups, namely kinematic- (4), spatiotemporal- (5), kinetic- (2), kinematic- and kinetic- (2), electromyographic- (1) and Inertial Measurement Unit-based indices (2).

INTERPRETATION

This work is one of the first reviews to summarize observational and instrumented gait indices, exploring their applicability in research and clinical contexts. The aim of this review is to assist members of these communities with the selection of the proper index for the group in analysis.

Therapeutic Effect of Multi-Channel Transcranial Direct Current Stimulation (M-tDCS) on Recovery of Cognitive Domains, Motor Functions of Paretic Hand and Gait in Subacute Stroke Survivors-A Randomized Controlled Trial Protocol

Background:

There has been rapid drift of rehabilitation professionals toward the clinical use of technology aided electrical interventions. Brain is a cortical hub of functionally related neural connections. Motor learning entails strong interaction with the cognitive domains. So better outcomes may be expected by optimally targeting functionally correlated areas simultaneously through tDCS.

Aim:

To determine the therapeutic effect of Multi Channel tDCS in combination with Functional electrical stimulation, SaeboFlex and conventional rehabilitation on recovery of Cognitive Domains, Motor Functions of Paretic Hand, and Gait in individuals with subacute Stroke.

Methods:

This is prospective, randomized, double blind controlled clinical trial. Subacute Stroke Survivors with the age Group (40-75 years) will constitute the Population of the study. Participants will be randomly allocated to experimental or control group. Participants of Experimental group will receive Multi channel tDCS, Functional electrical stimulation, Saebo Flex Training and conventional rehabilitation. Participants of the group B will receive FES, training with SaeboFlex, conventional physiotherapy intervention similar to as given to the participants of group A and sham multi channel tDCS.

Outcome Measures:

The primary outcome measures of the study will be Fugl Meyer assessment, Electroencephalogram and secondary outcome measures of the study will be Grip strength, Pinch strength, Nine hole peg test( NHPT), Wisconsin gait scale, Montreal cognitive assessment, Electroencephaloraphy to observe the cortical changes and tDCS adverse effect questionnaire and stroke specific quality of Life scale.

Statistical Analysis:

The primary analysis of the study will be done at the end of 4 weeks. Statistical analysis of data will be done using SPSS Version 22 with the help of a statistician.

Conclusion:

An insight into the therapeutic interventions augmenting, cognitive and motor domains simultaneously may yield better outcomes in the field of stroke rehabilitation thereby improving quality of life of stroke survivors

Assessment of Agreement Between a New Application to Compute the Wisconsin Gait Score and 3-Dimensional Gait Analysis, and Reliability of the Application in Stroke Patients

Currently, there are no computerized tools enabling objective interpretation of observational gait assessment based on Wisconsin Gait Scale (WGS), which is a reliable and well-tested tool. The solution envisaged by us may provide a practical tool for assessing gait deviations in patients with hemiparesis after stroke. The present study assessed agreement between a new application software for computerized WGS and 3-dimensional gait analysis (3DGA), and reliability of the application. The study involved 33 individuals with hemiparesis after stroke. The software was developed based on a model designed taking into account components of the WGS and incorporating auxiliary lines passing through the relevant anthropometric points on the patient’s body, as well as measurements of angular values, distances and duration of the specific gait phases, which make it possible to substantiate assessment based on this scale. Series of videos were made to record gait of the qualified patients. After the gait evaluation was carried out using the app, the data were retrieved from the software. The gait assessment was performed separately by three independent examiners who reviewed the video recording using the new app twice (two weeks apart). Additionally, 3DGA was carried out for all the subjects, and the results of the app-aided assessment were compared to those acquired using 3DGA. The findings show statistically significant correlations (p < 0.05) between majority of the WGS items measured using the new app, and the relevant spatiotemporal and kinematic parameters identified by 3DGA. Agreement between the scores reported by the three examiners was high in both measurements, as reflected by Cronbach’s alpha exceeding 0.8. The findings reflect very good intra-observer reliability (as reflected by kappa coefficients from 0.847 to 1) and inter-observer reliability (as reflected by kappa coefficients from 0.634 to 1) of the new application software for computerized WGS. The opportunities offered by the observational gait scale objectified through our new software for computerized WGS result from the fact that the tool provides a useful low-cost and time-effective feedback to monitor ongoing treatments or formulate hypotheses.

The accuracy and validity of the Sheffield Features of Gait Tool

Gait is now widely used in the UK as a contributor to identification, and increasing interest is being shown in its use in both Europe and the US. One of the long standing criticisms of the use of gait as evidence has been the lack of a validated standard methodology. With the publication of the 'Code of practice for forensic gait analysis', and the adoption of the code as part of the 'Codes of Practice and Conduct for forensic science providers and practitioners in the Criminal Justice System' by the Forensic Science Regulator, forensic gait analysts are now required to provide evidence of the testing of the methods used. The Sheffield Features of Gait Tool is specifically designed to assist observational gait analysis in the forensic context, and was developed by forensic gait analysis practitioners based on their casework and trial experience. Birch et al 2019 reported the findings of a study undertaken to assess the repeatability and reproducibility of the tool. This paper reports the findings of a study undertaken to assess the accuracy with which analysts identified features of gait when using the tool. Fourteen participants, with experience in observational gait analysis, viewed footage of computer generated avatars walking, and completed the features of gait tool on multiple occasions. The results showed a mean accuracy score of 134.92 out of a possible 180 (74.96%), a standard deviation of 9.49 (5.27%) and a coefficient of variation of 7.03%, demonstrating a good degree of consistency between the scores (Cronbach's alpha <0.90; ANOVA p-value <0.05). The findings of this study, coupled with those of the Birch et al 2019 study which showed there to be good levels of both repeatability and reproducibility of observations of features of gait made by the participants, suggest that the Sheffield Features of Gait Tool is a valid and fit for purpose method of observing and recording features of gait in the forensic context. The use of the tool provides the basis of a standardised methodology for observational gait analysis in the forensic context.

[Development of the Spanish version of the Wisconsin Gait Scale. Reliability and consistency analysis of spatial and temporal parameters with gait assessment in stroke patients]

BACKGROUND AND OBJECTIVE

We aimed to perform a cross-cultural adaptation of the Wisconsin Gait Scale (WGS) to Spanish and ensure its reliability, validity and sensitivity.

MATERIAL AND METHOD

A cross-sectional descriptive study was conducted in patients with stroke between September 2017 and March 2019. We developed the Spanish version through the translation-back-translation method, and reached a consensus on the problematic items. The Spanish version of the WGS was applied in 25 post-stroke patients, assessed in the Hospital Movement Analysis Unit. All patients were evaluated by 2 independent evaluators, subsequently performing the instrumented gait analysis using the Elite System (BTS), SMART System. Interobserver confirmation (intraclass correlation coefficient), internal consistency (Cronbach's alpha), and validation were verified by checking their relationship with spatial and temporal parameters and sensitivity to change (Pearson's correlation).

RESULTS

After the translation-back-translation, the committee found cultural equivalence in all but 2 items and reached a consensus on the final version. Interobserver reliability had an intraclass coefficient of 0.99 for the total score, and > 0.7 for each item; Cronbach's alpha was > 0.8; the validity between the WGS and the spatial and temporal parameters was significant (p < 0.05). Sensitivity to change was significant on comparison of the results of the scale at baseline and at 1 month (correlation coefficient 0.92).

CONCLUSION

The Spanish version of the WGS is a culturally equivalent instrument to the original version, providing an objective means to document observational analysis of gait in post-stroke patients by rehabilitation teams.

Can an Observational Gait Scale Produce a Result Consistent with Symmetry Indexes Obtained from 3-Dimensional Gait Analysis?: A Concurrent Validity Study

To investigate whether a simple observational tool may be a substitute to the time-consuming and costly 3-dimensional (3D) analysis, the study applied the Wisconsin Gait Scale (WGS), enabling assessment which is highly consistent with 3D gait parameters in patients after a stroke. The aim of this study was to determine whether, and to what extent, observational information obtained from WGS-based assessment can be applied to predict results of 3D gait analysis for selected symmetry indicators related to spatiotemporal and kinematic gait parameters. Fifty patients at a chronic stage of recovery post-stroke were enrolled in the study. The spatiotemporal and kinematic gait parameters were measured using a movement analysis system. The symmetry index (SI), was calculated for selected gait parameters. The patients’ gait was evaluated by means of the WGS. It was shown that stance % SI, as well as hip and knee flexion-extension range of motion SI can most effectively be substituted by WGS-based estimations (coefficient of determination exceeding 80%). It was shown that information acquired based on the WGS can be used to obtain results comparable to those achieved in 3D assessment for selected SIs of spatiotemporal and kinematic gait parameters. The study confirms that observation of gait using the WGS, which is an ordinal scale, is consistent with the selected aims of 3D assessment. Therefore, the scale can be used as a complementary tool in gait assessment.

Reliability and Minimal Detectable Change in the Gait Assessment and Intervention Tool in Patients With Multiple Sclerosis

BACKGROUND

Gait impairment is one of the main causes of disability in people with multiple sclerosis. The Gait Assessment and Intervention Tool is an observational gait scale that assesses kinematic parameters using video recordings.

OBJECTIVE

To study intra- and interrater reliability and the minimal detectable change of the Gait Assessment and Intervention Tool in individuals with multiple sclerosis.

DESIGN

Observational study.

SETTING

Multiple Sclerosis Foundation.

PARTICIPANTS

Thirty-five participants with multiple sclerosis were assessed (12 men, 23 women; 47.7 ± 11 y; Expanded Disability Status Scale = 4.32 ± 1.4).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASUREMENTS

Intra- and interrater reliability of the Gait Assessment and Intervention Tool was assessed for each limb using the Intraclass Correlation Coefficient. In addition, the minimal detectable change was calculated.

RESULTS

The Intraclass Correlation Coefficient for the intrarater reliability was found to be excellent for the total score both for the right side (.91; 95% confidence interval 95% CI .85-.95) and the left side (.93; 95% CI .88-.96). The intraclass correlation coefficient for the interrater reliability was .91 (95% CI .85-.95) for the right side, and .93 (95% CI .88-.96) for the left side. The minimal detectable change for the intrarater reliability was 1.19 points for the right side and .77 for the left side.

CONCLUSIONS

The Gait Assessment and Intervention Tool exhibits excellent intra- and interrater reliability and a small minimal detectable change for people with multiple sclerosis.

Post-stroke Visual Gait Measure for Developing Countries: A Reliability and Validity Study

Background

Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. The Rivermead Visual Gait Assessment (RVGA) is a one such measure that assesses the kinematic aspect of the gait deviations in stroke. However, the available information on psycho-clinocometric properties of the measure is not adequate.

Objective

To establish reliability and validity of RVGA using walking-videos of the post-stroke subjects.

Methods

Design: Observational study.

Setting

A rehabilitation institute Participants: A convenience sample of 40 chronic stroke patients.

Outcome Measures

RVGA, Fugl-Meyer assessment (lower extremity), 10-m walk test, Time up and go test, and Berg balance scale (BBS).

Procedure

Walking was video-taped from the anterior aspect, posterior aspect, affected side, and less-affected side. After coding the tapes, a research staff member provided them to four different raters in a random order. Each rater scored the coded video on the RVGA data collection sheet twice: one at the baseline and another after 1 month to eliminate any recollection of the initial assessment.

Results

The findings exhibit that there was good-to-excellent agreement between the scores of the raters and also between the assessments (correlation coefficient = 0.94 to 0.95; P < 0.001). The measure also exhibits acceptable validity when correlated with scores of BBS (r = 0.4; P < 0.001).

Conclusion

Video-based RVGA is a reliable and valid tool to assess gait-related impairment in post-stroke hemiparesis. This cost-effective measure may be incorporated in the clinical and research practice to discern and quantify complex phenomenon of the gait deviation. RVGA may be considered as a useful tool, especially in developing countries where expensive gait analyzer is usually not available.

The repeatability and reproducibility of the Sheffield Features of Gait Tool

Gait, the pattern or style in which locomotion is undertaken, has kinematic characteristics that may occur in varying proportions of a population and therefore have discriminatory potential. Forensic gait analysis is the analysis, comparison and evaluation of features of gait to assist the investigation of crime. While there have been recent developments in automated gait recognition systems, gait analysis presented in criminal court to assist in identification currently relies on observational analysis by expert witnesses. Observational gait analysis has been the focus of considerable research, and it has been shown that the adoption of a systematic approach to both the observation and recording of features of gait improves the reliability of the analysis. The Sheffield Features of Gait Tool was developed by forensic gait analysis practitioners based on their casework and trial experience, and consists of more than a hundred features of gait and variances. This paper reports the findings of a study undertaken to assess the repeatability and reproducibility of the Sheffield Features of Gait Tool. Fourteen participants, with experience in observational gait analysis, viewed footage of computer generated avatars walking, and completed the features of gait tool on multiple occasions. The repeatability scores varied between participants from a highest score of 42.59 out of a maximum possible score of 45 (94.65%), to a lowest score of 30.76 (68.35%), with a mean score of 35.79 (79.54%) and a standard deviation of 3.59 (7.98%). The reproducibility scores for the assessment of each avatar varied from a highest score of 137.73 out of the best possible score of 180 (76.52%), to a lowest score of 127.21 (70.67%), with a mean score of 132.21 (73.45) and a standard deviation of 3.82 (2.12%). The results demonstrated that the use of the Sheffield Features of Gait Tool by experienced analysists resulted in what could be considered to be good levels of both repeatability and reproducibility. Some variation was shown to occur both between the results produced by different analysts, and between those produced from the analysis of different avatars. An understanding of the probative value of gait analysis evidence is an important facet of its submission as evidence, and the design and testing of standardized methods of analysis and comparison are an essential element of developing that understanding. This study is the first to test a purpose designed features of gait tool for use in forensic gait analysis.

An observational treatment-based gait pattern classification method for targeting interventions for older adult males with mobility problems: Validity based on movement control and biomechanical factors

BACKGROUND

A reliable and valid observational gait assessment intended to guide clinical intervention for gait deficits in older adults has not been proposed. A quick gait classification method which tailors clinical management for different patterns of gait dysfunction may be useful for clinicians with limited access to apply computer-assisted gait analyses.

RESEARCH QUESTION

This work aims to establish reliability and validity of the Treatment-Based Gait Pattern Classification (TBGPC) that can be used to quickly identify and classify mobility problems of older males, and possibly target interventions for specific gait deficits in clinical settings.

METHOD

Videotapes of 116 older male veterans referred for mobility problems were analyzed in this cross-sectional study. The TBGPC defined by movement control (consistent, inconsistent) and postural biomechanical factors (usual, flexed, extended, crouched) was validated by comparing means of individual items of the Modified Gait Abnormality Rating Scale (GARS-M) across groups.

RESULTS

Kappas for interrater reliability of the TBGPC movement control and biomechanical components were 0.59 and 0.75, respectively; for intrarater reliability, 0.82 and 0.72, respectively. Both movement control and biomechanical components were validated. All GARS-M items were different between older males with consistent and inconsistent gait. Within the consistent and inconsistent group, hip ROM was one of the most differentiating GARS-M item between older males with usual and flexed gait and flexed and crouched group. Total GARS-M score and guardedness were two differentiating factors between the usual and crouched group.

SIGNIFICANCE

Gait patterns of older males were reliably recognized and validated by mean differences in abnormal characteristics of gait across patterns. The TBGPC may be useful to quickly identify and classify mobility problems of older males and to guide clinical intervention.

Construct validity of the Wisconsin Gait Scale in acute, subacute and chronic stroke

OBJECTIVE

To assess the construct validity of the Wisconsin Gait Scale (WGS) in subjects after stroke.

METHODS

A retrospective observational study was conducted at inpatient rehabilitation hospital. Data from 61 stroke patients was compiled. The Functional Ambulatory Categories (FAC), the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS), the Barthel Index (BI) and the Functional Independence Measure (FIM) were selected to analyze the WGS construct validity at four specific time points after stroke (acute, subacute and chronic stages). Spearman correlation coefficients investigated the relationship between WGS and clinical measures.

RESULTS

The construct validity of the WGS in patients with stroke at acute stage was moderate with the FAC (r=-.773), the BBS (r=-.676), the PASS (r=-.646) and the FIM (r=-.592). At subacute stage, the construct validity of the WGS was excellent with the FAC (r=-878), the BBS (r=-.882), the PASS (r=-.847) and the BI (r=-.813). The correlation was moderate with the FIM (r=-.693). At six and twelve months, the construct validity of WGS with the FAC, the BBS, the PASS, the BI and the FIM was excellent (r ≥ .8).

CONCLUSION

The WGS has moderate construct validity with walking, balance and functionality scales in patients with acute stroke. The correlation with the FAC, the BBS, the PASS and the BI at subacute and chronic stages was excellent.

Relationship Between Observational Wisconsin Gait Scale, Gait Deviation Index, and Gait Variability Index in Individuals Poststroke

OBJECTIVE

To compare results of the observational Wisconsin Gait Scale (WGS) and global gait indexes such as Gait Deviation Index (GDI) and Gait Variability Index (GVI), constituting an objective method of assessing gait, and taking into account parameters identified during 3-dimensional gait analysis (3DGA).

DESIGN

A validation study.

SETTING

Rehabilitation clinic.

PARTICIPANTS

A total of 50 individuals poststroke and 50 individuals without stroke and without gait disorders (N=100).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Gait was evaluated using the WGS. GDI and GVI values were acquired using a movement analysis system. The global gait indexes GDI and GVI were determined based on the kinematic and spatiotemporal parameters, respectively.

RESULTS

The study showed statistically significant correlations between the parameters of GDI affected leg and WGS total score (R=-0.87), GVI affected leg and WGS total score (R=-0.93), GVI unaffected leg and WGS total score (R=-0.88), GVI affected/unaffected leg and the total score in the assessment of spatiotemporal parameters on the WGS (R=-0.81) as well as GDI affected leg and the total score in the assessment of kinematics parameters on the WGS (R=-0.85). All correlations were strong (0.7<|R|<0.9) or very strong (0.9<|R|<1).

CONCLUSIONS

WGS scores have a strong or very strong correlation with GDI and GVI. The WGS may be recommended as a substitute tool to be used when 3DGA is unavailable, as it is a useful ordinal scale, enabling simple and accurate observational assessment of gait in patients poststroke, with effectiveness that is comparable to the GDI and GVI.

Test-retest reliability of physiotherapists using the action research arm test in chronic stroke

[Purpose] The aim of this study was to determine whether physiotherapists (PT) scores are consistent over time when using Action Research Arm Test (ARAT) to assess upper limb (UL) function on a videotaped chronic stroke patient. [Participants and Methods] Quantitative correlational study. A convenience-snowball sample of 20 international PT (mean age and experience=32 ± 6.8 and 7.55 ± 7.4 years) used ARAT to score chronic stroke patient’s UL function, observing a video at baseline and again ≈ 2 weeks later. Two sets of non-parametric ordinal data were assessed with Spearman’s (rho) and the alpha (a) value was set at 0.01. Line of equality, Bland-Altman plots and Wilcoxon signed rank test were also considered. [Results] Spearman’s rho was found ≈ 0.78 at a significance level of 0.00. ARAT was scored with a mean difference of 16.6 days and a mean change of 0.6 points was observed. Limits of agreement and coefficient of reproducibility were ± 2.3 and ± 2.6 respectively. The patient’s arm impairment was categorised as moderate and floor or ceiling effects were not detected. [Conclusion] The results suggest that ARAT is consistent, valid and should be used by PT in chronic stroke.

The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study

Background

In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy.

Methods

The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined.

Results

The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman’s rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists.

Conclusions

The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters.

Trial registration

anzctr.org.au, ID: ACTRN12617000436370. Registered 24 March 2017.

Effectiveness of prowling with proprioceptive training on knee hyperextension among stroke subjects using videographic observation- a randomised controlled trial

INTRODUCTION

Knee hyperextension is seen in 40-68% of ambulating hemiparetics. If left untreated it may lead to laxity of posterior structures of knee resulting in early degeneration of knee leading to pain, reduced independence in activities of daily living (ADL), deformities and instability. In this study we hypothesize walking with bent knee attitude (prowling) along with proprioceptive training may help to reduce knee hyperextension during the stance phase of gait cycle.

OBJECTIVE

To test the efficacy of prowling along with proprioceptive training on knee hyperextension range, dorsiflexion range and spatio temporal parameters of gait using Wisconsin gait scale (WGS) as compared to routine physiotherapy.

METHOD

32 subjects were randomized into 2 groups- experimental and control groups. Both the groups were given routine physiotherapy. Experimental group received an additional treatment consisting of prowling along with proprioceptive training. Knee hyperextension and ankle dorsiflexion ranges were videotaped and analysed using Kinovea software, and for spatio-temporal gait parameters WGS was used.

RESULTS

In our study, the experimental group showed significant improvement over the control group with regards to knee hyperextension, dorsiflexion range and WGS score. Pre post intervention analysis, within the group, for time taken to cover the distance revealed significant improvement, however between group analysis did not reveal any significant difference.

CONCLUSION

Prowling along with proprioceptive training is effective in reducing knee hyperextension, increasing dorsiflexion range and improving spatio-temporal gait parameters.

Development and Validation of a Novel Motor-Cognitive Assessment Strategy of Compensatory Sit-to-Stand Maneuvers in People With Dementia

BACKGROUND AND PURPOSE

People with dementia show disease-specific sit-to-stand (STS) movement disorders, which relate to deficits of integrating cognitive aspects of motor processes into motor action organization. During STS training in rehabilitation therapy, compensatory STS movement maneuvers are taught aiming to improve patients' STS ability. Previous clinical STS measures do not address these maneuvers or assess cognitive aspects of their motor action organization. The purpose of this study was to develop and validate a motor-cognitive STS assessment instrument for people with dementia (Assessment of Compensatory Sit-to-Stand Maneuvers in People With Dementia, ACSID).

METHODS

The ACSID covers the recall, initiation, and effective performance of compensatory STS movement maneuvers. The inter- and intrarater reliability, concurrent validity, sensitivity to change, and feasibility were investigated by secondary analysis of data of 97 participants from a randomized controlled trial to improve motor-cognitive performances in people with mild to moderate dementia (mean [standard deviation] age: 82.5 [5.9] years, Mini-Mental Status Examination: 21.9 [2.9] points). Concurrent validity of the individual ACSID items was assessed against reference criteria derived from video-motion analysis.

RESULTS

Good to excellent inter- (kappa [κ] = 0.64-0.99; intraclass correlation coefficient [ICC] = 0.74-0.89) and intrarater (κ= 0.77-0.91; ICC = 0.77-0.91), concurrent validity (point-biserial correlation coefficients = |0.56|-|0.84|), and sensitivity to change (standardized response means = 0.61-1.00) were found. Feasibility was excellent with a high completion rate (96.9%), no critical events during assessment, and no floor or ceiling effects.

CONCLUSIONS

The ACSID represents the first observation-based assessment instrument to document motor and cognitive aspects in the execution of a motor key feature in people with dementia, and has been shown to be reliable, valid, feasible, and sensitive to intervention-induced changes.

Analysis of consistency between temporospatial gait parameters and gait assessment with the use of Wisconsin Gait Scale in post-stroke patients

INTRODUCTION

Due to the increasing incidence and social effects of stroke there is a growing interest in finding methods enabling gait analysis in this group of patients. Observational techniques are predominantly applied in clinical practice; on the other hand advanced quantitative methods allow in-depth multidimensional gait assessment. The present study was designed to assess the consistency between temporospatial gait parameters acquired through 3-dimensional gait analysis and the results of gait assessment with the use of observational WGS in post stroke hemiparetic patients.

MATERIAL AND METHOD

The study was performed in a group of 30 post-stroke patients, over 6 months from the onset of ischaemic stroke, who were able to walk unassisted. Gait assessment based on WGS was performed by an experienced physiotherapist, with the use of video recordings. Assessment of temporospatial parameters was based on gait analysis performed with BTS Smart system.

RESULTS

The findings show moderate correlation between WGS based gait assessment and gait velocity (r=-0.39; p=0.0316). Similar relationship was identified between gait cycle duration and score in WGS for both unaffected (r=-0.36; p=0.0477) and affected side (r=-0.37; p=0.0426). Higher correlation level was demonstrated for stance phase on the unaffected side and gait assessment based on WGS (r=0.58; p=0.0009).

CONCLUSIONS

Gait assessments with the use of temporospatial parameters and with observational WGS were found to produce moderate and good consistent results. WSG is a useful, simple tool for assessing gait in post stroke hemiparetic patients.