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To investigate the test–retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test–retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland–Altman plots, were examined. Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient – ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test–retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes. [ABSTRACT FROM AUTHOR]

To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority. A single-point cane may not improve spatiotemporal parameters of walking after stroke. Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking. Canes may be prescribed without the fear of negatively impairing walking kinematics. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design: Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results: Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Conclusion: Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities. [ABSTRACT FROM AUTHOR]

Background: Backward walking training has gained popularity as an alternate type of training for improving walking and cardiorespiratory fitness.1 Aim: To examine the effects of backward walking training in comparison with forward walking training for improving walking after stroke. Methods: A systematic review of randomized trials was performed. Searches were conducted on AMED, Cochrane Library, EMBASE, LILACS, MEDLINE, Scielo and PEDro databases. Participants were ambulatory adults after stroke. The experimental intervention was backward walking training. Outcome data related to walking speed, cadence and stride length were combined in meta-analyses. The quality of trials was assessed by the PEDro scores, and the quality of evidence was determined according to the GRADE system. Results: Six trials (PEDro score 6), involving 156 participants, were included. The mean age of participants ranged from 50 to 69 years old. Moderate-quality evidence suggested that backward walking training is as effective or better than forward walking training for improving walking speed (MD 0.16 m/s, 95% CI 0.06 to 0.27). Effects on cadence (MD 3 steps/min, 95% CI -2 to 6) and stride length (MD 0.03 m, 95% CI -0.02 to 0.09) were very similar between interventions. Conclusion: This review provided evidence that the effect of backward walking training is similar to or better than the effect of forward walking training for improving walking speed after stroke. [ABSTRACT FROM AUTHOR]

Background: It is well recognized that the negative motor impairments following upper motor neuron damage, e.g., loss of strength and dexterity (motor coordination), mostly contribute to disability. Many factors may predict impairments in motor coordination (MC) and the identifications of these factors could help rehabilitation professionals to select variables to be considered in the evaluation and interventions aimed at improving MC of the lower limbs after stroke., Aim: To investigate the potential predictors of motor coordination (MC) of the paretic lower limb with stroke subjects, as assessed by the Lower Limb Motor Coordination Test (LEMOCOT)., Design: Cross-sectional, observational study., Setting: University laboratory., Population: One hundred and six stroke subjects., Methods: The selected potential predictors of the LEMOCOT scores were age, gender, motor recovery and sensation of the lower limb, tonus of the knee extensor and plantar flexor muscles, and strength of the hip flexor and knee flexor/extensor muscles. Step-wise multiple regression was employed for analysis., Results: Only motor recovery, tonus of the plantar flexor muscles, and age reached significance (P<0.05) and, consequently, were kept in the model. Motor recovery alone was able to explain 46% (F=89.0, P<0.001) of the variance in the LEMOCOT scores. When tonus of the plantar flexor muscles and age were included in the model, the explained variance increased to 54% (F=42.0, P<0.001). Lower limb motor recovery was positively associated with the LEMOCOT scores, whereas the tonus of the plantar flexor muscles and age were negatively correlated., Conclusions: Motor recovery of the lower limb, tonus of the plantar flexor muscles, and age were significant predictors of MC of the paretic lower limb., Clinical Rehabilitation Impact: These findings could help rehabilitation professionals to evaluate MC deficits and plan interventions aimed at improving MC of the lower limbs for stroke subjects, based upon the knowledge of the possible factors that could contribute to MC impairments.