A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors

Background: Although there is evidence that stroke survivors have reduced gait adaptability, theunderlying mechanisms and the relationship to functional recovery are largely unknown. We exploredthe relationships between walking adaptability and clinical measures of balance, motor recovery andfunctional ability in stroke survivors.Methods: Stroke survivors (n = 42) stepped to targets, on a 6 m walkway, placed to elicit steplengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missedduring six walks and target stepping speed was recorded. Fugl–Meyer (FM), Berg Balance Scale (BBS),self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (usingGaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was usedto model the relationships between: total targets missed, number missed with paretic and non-pareticlegs, target stepping speed, and each clinical measure.Results: Regression revealed a significant model for each outcome variable that included only oneindependent variable. Targets missed by the paretic limb, was a significant predictor of FM (F(1,40) = 6.54,p = 0.014,). Speed of target stepping was a significant predictor of each of BBS (F(1,40) = 26.36, p < 0.0001),SSWS (F(1,40) = 37.00, p < 0.0001). No variables were significant predictors of SL or SS asymmetry.Discussion: Speed of target stepping was significantly predictive of BBS and SSWS and paretic targetsmissed predicted FM, suggesting that fast target stepping requires good balance and accurate steppingdemands good paretic leg function. The relationships between these parameters indicate gaitadaptability is a clinically meaningful target for measurement and treatment of functionally adaptivewalking ability in stroke survivors