Spatial-Temporal Gait Variability Poststroke: Variations in Measurement and Implications for Measuring Change

Objective: To determine the responsiveness to change of spatial-temporal gait parameters among stroke survivors for 3 different variability measures: SD, coefficient of variation (CV), and median absolute deviation (MAD). Design: Retrospective chart review. Setting: Clinical laboratory in a Canadian hospital. Participants: Stroke survivors (N=74) receiving inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: Spatial-temporal gait variability was calculated for step length, step width, stance time, swing time, and double support time. Responsiveness to change was determined by comparing (1) trials without versus trials with a concurrent cognitive task and (2) admission to discharge from rehabilitation. Results: Variability estimators (SD, CV, and MAD) increased with the addition of a cognitive task and decreased from admission to discharge of rehabilitation. However, these changes were not statistically significant when change in gait velocity was included as a covariate. The effect size values were similar for all variability estimators with a trend toward a greater SD response to temporal parameters. The CV displayed a larger response to change for step length than did the SD and MAD. Although gait variability decreased between admission and discharge, the effect size was larger for the condition without the cognitive task than for the condition with the cognitive task. Conclusions: Our results show that gait variability estimators demonstrate a similar responsiveness to a concurrent cognitive task and improved walking ability with recovery from stroke. Future work may focus on evaluating the clinical utility of these measures in relation to informing therapy and response to gait-specific training protocols. (C) 2014 by the American Congress of Rehabilitation Medicine