Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke: a pilot study Pontus Andersson1 and Erika Franzén2,3 Segeltorp Physiotherapy Ltd., Stockholm, Sweden, 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden, 3Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden 1
Background: People with gait difficulties after a stroke usually have an asymmetrical gait and slower gait speed than age-matched controls. These difficulties restrict people with stroke in their daily life activities. Objective: This pilot study sought to evaluate the effects of weight-shift training on gait, weight distribution in standing, and ambulation in people with gait difficulties after a stroke. Methods: Ten subjects with chronic stroke (3–11 years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program. Spatial and temporal gait parameters were assessed pre-, post-, and 3-month post-training with a motion analysis system. Weight distribution was assessed with force plates and ambulation with the Swedish version of the Clinical Outcome Variables Scale (S-COVS). Wilcoxon signed-rank tests were used to explore differences between test occasions. Results: Significant changes were seen between pre-and post-tests in decreased stance time on the non-paretic leg (P = 0.005) and increased score on the S-COVS (P = 0.043). At the 3-month follow-up test, the subjects had also increased their gait speed significantly (P = 0.037). Standing weight distribution did not change between pre- and post-tests (P = 0.575), but between the pre-and follow-up tests it shifted from the paretic leg to the non-paretic (P = 0.007). Conclusion: Weight-shift training seems to improve gait and ambulation in subjects with chronic stroke, but not with standing weight distribution. However, this pilot study has several limitations and a larger sample size with a control group is necessary. Keywords: Exercise, Gait, Asymmetry, Force Plate, Cerebral lesion
Introduction
Motor function may improve early after stroke, thanks to recovery of marginally functional neurons, and later to reorganization or relearning of neural functions, i.e., neuroplasticity.1,2 Critical principles of motor learning include: mimicking of movements of everyday life,3 muscle activation with focused attention,4 repetition of desired movements5, and training specificity.6 The most often-stated goal of stroke sufferers is improved ambulation and gait function.7–9 Gait function, represented by gait speed, is highly correlated to gait asymmetry.10,11 The asymmetrical gait commonly seen in stroke often Correspondence to: Erika Franzén, Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden. Email: [email protected] © W. S. Maney & Son Ltd 2016 DOI 10.1179/1074935715Z.0000000052
originates in the inability to maintain single-limb support on the paretic leg for the same duration as on the non-paretic leg.12 Therefore, to improve gait symmetry, training to shift weight toward the paretic leg during gait should be important. The unwillingness to shift, or anxiety about shifting, weight to the paretic leg in stroke subjects is a logical response since the paretic side often has muscle weakness,13 restricted joint movement,14 limited sensory input and perception problems originating in the brain15,16, or even neglect.17,18 The exception is patients with pusher syndrome who, on the contrary, shift weight toward their paretic side.19 These patients are often trained with wall-support on their non-paretic side to prevent them from pushing.19 Training patients without ‘pusher syndrome’, by far the largest group,20 using wall-support on the paretic side, instead, might work as a somatosensory Topics in Stroke Rehabilitation 2015 VOL. 22
NO.
6
437
Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
input helping the person to correct symmetry as well as constituting a safety measure to prevent falls, common among the stroke population.21,22 Our group has recently shown improved balance control in individuals with chronic stroke after training static and dynamic balance with visual feedback and gait training with wall-support.23 While the wall-supported gait training might have contributed to improved balance control, the effects on gait have not previously been evaluated. The simplicity and easily accessible qualities of this training method, combined with the possibility of incorporating the principles of motor learning, prompted us to investigate this training method, particularly its effect on gait, ambulation, and standing weight distribution in people with gait difficulties after a stroke.
Materials and Methods Subjects
Ten subjects (four females) with chronic stroke (3–11 years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program with a 3-month follow-up. Mean age was 70.2, SD 10.9 years. Five had suffered a lesion in their right hemisphere and five in the left, see Table 1 for subject characteristics. Subjects were included if gait difficulties remained at least 6 months after stroke, and if they had been clinically evaluated by a physical therapist as having asymmetrical gait, and were using walking aids due to their stroke. Subjects were excluded if they either were incapable of understanding and/or following instructions or could walk less than 20 m with or without walking aids. The subjects were recruited from three outpatient physical therapy clinics in the vicinity of Stockholm. Twelve subjects were initially enrolled, but two were excluded, one due to a cardiac infarction before the training period and one for personal reasons during the training period. Informed consent was obtained from each subject and the project was approved by the local Ethics Committee in Stockholm (2005/179-31/4).
Table 1 Subjects’ demographics Subject
Age (years)
1 2 3 4 5 6 7 8 9 10 Median
72 76 62 43 81 72 63 77 72 73 72
Gender
Paretic Time since side stroke (years)
M F F F M F M M M M
left right left right right right left left right left
7 4 3 6 10 8 5 11 4 6 6
Topics in Stroke Rehabilitation 2015 VOL. 22
NO.
A single-group pre-test and post-test design with a 3-month follow-up was used. At baseline, clinical and laboratory measurements were taken on each subject. This was followed by 3 weeks of individual training four times a week. The measurements were repeated directly after the training period and again 3 months post intervention. The subjects were not allowed to participate in any other type of training, besides their regular daily-life activities from the start of the intervention until the follow-up test was completed. All measurements were blinded to the physical therapist leading the training. During the laboratory measurements, the subjects wore their regular socks and shoes, tight cycle-shorts, and nothing on the upper body (bra on females). The laboratory measurements always started with standing weight distribution. The subjects were instructed to stand in their preferred stance with one foot on each force plate imbedded in the floor. The distance between the heels was measured to ensure accurate reproduction in the follow-up measurements. Sway data from the force plates were then recorded for 10 seconds. Gait parameters were recorded while the subject walked for 10 trials at their preferred speed along 7 m-long walkway. After the laboratory measurements, each subject's ambulation (S-COVS) was assessed within 3 days at another location to limit the influence of fatigue on the measurements.
Gait parameters
The gait analyses was performed using an ELITE 2000 system (BTS Incorporated, Milan, Italy) composed of eight optoelectronic cameras recording kinematic data with a sampling frequency of 100 Hz and a calibrated space of 2 × 2 × 2 minutes. Twenty-two spherical reflective markers with a diameter of 15 mm were applied to the skin with double-sided tape over specific anatomical landmarks on lower limbs according to Davis's protocol.24 Gait cycle events were defined interactively with GAIT Eliclinic software (BTS Inc.) by defining heel strike, toeoff, and heel strike again from the kinetics and kinematics. Gait cycle time was normalized to 100% and temporal and spatial gait parameters were calculated in the software.
Standing weight distribution
Two 500 × 500 mm force plates (Kistler, Winterthur, Switzerland) were used to record three-dimensional ground reaction forces at a sampling frequency of 100 Hz. An index of asymmetry of the vertical force (Fz) between paretic and non-paretic leg was calculated for each trial25 as follows:
Fz ofpareticleg–perfectsymmetry (meanofFz ofbothlegs) perfectsymmetry (1)
M: male; f: female. 438
Procedure
6
Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
Zero percent indicates symmetry between sides and 100% indicates maximal asymmetry between sides. Positive values indicate greater loading on paretic side.
Ambulation
Ambulation was assessed with the Swedish Clinical Outcome Variables Scale (S-COVS).26 This scale consists of 13 motor tasks where the examiner rates from 1 (dependent) to 7 (normal) the level of performance in different motor tasks. The test permits measurement of activities regarding transportation, gait, postural control in sitting position, handling a wheel-chair, and arm/hand function. In this study, only items five to eight, representing ambulation variables, were assessed. These were human support, walking aids, endurance, and velocity. The individual scores were summarized (maximum 28). The S-COVS was run before, directly after and 3 months after training. It has been tested for inter-rater reliability for the total scores of the test and showed a 0.97 correlation coefficient: 0.93 for the specific items used in this study.26
Intervention
The training period consisted of four 1 hour sessions a week for 3 weeks. Every subject trained individually with the same physical therapist. The subjects’ symmetry training consisted of three tasks: 1) walking with wall-support (Fig. 1A): the subjects walked with the paretic side close to a wall. They were instructed to place the foot of the paretic leg on a 3- cm-wide and 10- m-long line running 20 cm from the wall. During the stance phase of the paretic leg, the subjects were instructed to shift their trunk so that the shoulder of the affected side touched the wall. Wearing regular shoes, they walked along the wall in this manner 10 times in three sets with 2 minutes rest between each set.
2) stepping up and down on a platform with wall-support (Fig. 1B): the subjects stepped, with the paretic side nearest the wall, up onto a 14- cm high, 90- cm long, and 35- cm wide platform. They had to step up and down walking forwards and then backwards, always with the paretic side against the wall. To be able to step and lift the non-paretic leg, the subjects had to transfer weight to the paretic leg so that the shoulder of the paretic side touched the wall. This task was executed 10 times in three sets with 2 minutes break between each set. 3) sitting down and rising from a chair with wall-support (Fig. 1C): the subjects sat on a chair without armrests, with the paretic side close to a wall. The paretic foot was positioned with a fairly large knee angle ( ≤ 90°) closer to the chair than the non-paretic foot. The subjects had to stand up and sit down while shifting body weight to the paretic side so that the shoulder of the paretic side touched the wall. They repeated the task 15 times in three sets with 2 minutes break between each set.
In the first session, the subjects were told to lean toward the wall during the stance phase on the paretic leg. This was to make them feel their weight bearing and the contact of the shoulder with the wall. The wall was used to create a somatosensory input for the subjects to know when they had executed the right weight transfer. Many subjects said they were afraid of falling when shifting their weight toward the paretic side, so the wall was a safety item preventing them from falling. As soon as the subjects had learned to control the weigh shift, they were asked to do the exercises without touching the wall. The goal was to walk without the wall as a touch reference or safety item. The progression from having the subjects lean toward the wall to not touching the wall was decided by the clinician as soon as the subjects managed to control their weight shift with the right amount of force to touch the wall, not missing it or hitting it too hard, and managed this in a 10 m session. The
Figure 1 The intervention: symmetry-training in three different tasks. Left panel (A): walking with wall-support. Middle panel (B): stepping up and down on a platform with wall-support. Right panel (C): rising from and sitting down on a chair with wall-support.
Topics in Stroke Rehabilitation 2015 VOL. 22
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Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
Table 2 Gait parameters for paretic and non-paretic side, median (range)
Variable
Pre-
Post-
Velocity (m/s)
0.65 (0.2–1.1)
0.67 (0.2–1.2)
Cadence (steps/ min)
88.9 (47.5– 107.5)
88.4 (46.5– 111.8)
3-month follow-up 0.72 (0.3–1.2)
92.6 (57.0– 117.8)
Paretic Step length (mm)
431 (240–655)
Stride length (mm)
813 (561– 1263)
Stance time (ms)
709 (530– 1505)
835 (603– 1785)
739 (565– 1243)
Stance phase (% gait cycle)
57 (43–59)
56 (50–63)
56 (53–60)
Non-paretic Step length (mm)
440
452 (204–559)
871 (552– 1293)
Stride length (mm)
829 (585– 1311)
Stance time (ms)
878 (643– 1935)
400 (284–665)
883 (495– 1214)
795 (448– 1768)
T1–T2 P = 0.203 T1–T3 P = 0.037 T2–T3 P = 0.074 T1–T2 P = 0.203 T1–T3 P = 0.074 T2–T3 P = 0.241
464 (253–609)
T1–T2 P = 0.507
903 (504– 1348)
T1–T3 P = 0.575 T2–T3 P = 0.059 T1–T2 P = 0.139 T1–T3 P = 0.059 T2–T3 P = 0.444 T1–T2 P = 0.093 T1–T3 P = 0.959 T2–T3 P = 0.203 T1–T2 P = 0.047
428 (263–724)
T1–T2 P = 0.241
885 (263–724)
T1–T3 P = 0.332 T2–T3 P = 0.959 T1–T2 P = 0.721
734 (498– 1510)
Topics in Stroke Rehabilitation 2015 VOL. 22
Pre-
Post-
3-month follow-up
P-value
T1–T3 P = 0.169 T2–T3 P = 0.415 371 (222–620)
Variable
T1–T3 P = 0.878 T2–T3 P = 0.074 T1–T2 P = 0.005 T1–T3 P = 0.005
NO.
6
Stance phase (% gait cycle)
62 (52–76)
59 (43–74)
58 (49–72)
P-value T2–T3 P = 0.444 T1–T2 P = 0.037 T1–T3 P = 0.218 T2–T3 P = 1.000
Bold indicates P
Background: People with gait difficulties after a stroke usually have an asymmetrical gait and slower gait speed than age-matched controls. These difficulties restrict people with stroke in their daily life activities. Objective: This pilot study sought to evaluate the effects of weight-shift training on gait, weight distribution in standing, and ambulation in people with gait difficulties after a stroke. Methods: Ten subjects with chronic stroke (3–11 years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program. Spatial and temporal gait parameters were assessed pre-, post-, and 3-month post-training with a motion analysis system. Weight distribution was assessed with force plates and ambulation with the Swedish version of the Clinical Outcome Variables Scale (S-COVS). Wilcoxon signed-rank tests were used to explore differences between test occasions. Results: Significant changes were seen between pre-and post-tests in decreased stance time on the non-paretic leg (P = 0.005) and increased score on the S-COVS (P = 0.043). At the 3-month follow-up test, the subjects had also increased their gait speed significantly (P = 0.037). Standing weight distribution did not change between pre- and post-tests (P = 0.575), but between the pre-and follow-up tests it shifted from the paretic leg to the non-paretic (P = 0.007). Conclusion: Weight-shift training seems to improve gait and ambulation in subjects with chronic stroke, but not with standing weight distribution. However, this pilot study has several limitations and a larger sample size with a control group is necessary. Keywords: Exercise, Gait, Asymmetry, Force Plate, Cerebral lesion
Introduction
Motor function may improve early after stroke, thanks to recovery of marginally functional neurons, and later to reorganization or relearning of neural functions, i.e., neuroplasticity.1,2 Critical principles of motor learning include: mimicking of movements of everyday life,3 muscle activation with focused attention,4 repetition of desired movements5, and training specificity.6 The most often-stated goal of stroke sufferers is improved ambulation and gait function.7–9 Gait function, represented by gait speed, is highly correlated to gait asymmetry.10,11 The asymmetrical gait commonly seen in stroke often Correspondence to: Erika Franzén, Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden. Email: [email protected] © W. S. Maney & Son Ltd 2016 DOI 10.1179/1074935715Z.0000000052
originates in the inability to maintain single-limb support on the paretic leg for the same duration as on the non-paretic leg.12 Therefore, to improve gait symmetry, training to shift weight toward the paretic leg during gait should be important. The unwillingness to shift, or anxiety about shifting, weight to the paretic leg in stroke subjects is a logical response since the paretic side often has muscle weakness,13 restricted joint movement,14 limited sensory input and perception problems originating in the brain15,16, or even neglect.17,18 The exception is patients with pusher syndrome who, on the contrary, shift weight toward their paretic side.19 These patients are often trained with wall-support on their non-paretic side to prevent them from pushing.19 Training patients without ‘pusher syndrome’, by far the largest group,20 using wall-support on the paretic side, instead, might work as a somatosensory Topics in Stroke Rehabilitation 2015 VOL. 22
NO.
6
437
Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
input helping the person to correct symmetry as well as constituting a safety measure to prevent falls, common among the stroke population.21,22 Our group has recently shown improved balance control in individuals with chronic stroke after training static and dynamic balance with visual feedback and gait training with wall-support.23 While the wall-supported gait training might have contributed to improved balance control, the effects on gait have not previously been evaluated. The simplicity and easily accessible qualities of this training method, combined with the possibility of incorporating the principles of motor learning, prompted us to investigate this training method, particularly its effect on gait, ambulation, and standing weight distribution in people with gait difficulties after a stroke.
Materials and Methods Subjects
Ten subjects (four females) with chronic stroke (3–11 years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program with a 3-month follow-up. Mean age was 70.2, SD 10.9 years. Five had suffered a lesion in their right hemisphere and five in the left, see Table 1 for subject characteristics. Subjects were included if gait difficulties remained at least 6 months after stroke, and if they had been clinically evaluated by a physical therapist as having asymmetrical gait, and were using walking aids due to their stroke. Subjects were excluded if they either were incapable of understanding and/or following instructions or could walk less than 20 m with or without walking aids. The subjects were recruited from three outpatient physical therapy clinics in the vicinity of Stockholm. Twelve subjects were initially enrolled, but two were excluded, one due to a cardiac infarction before the training period and one for personal reasons during the training period. Informed consent was obtained from each subject and the project was approved by the local Ethics Committee in Stockholm (2005/179-31/4).
Table 1 Subjects’ demographics Subject
Age (years)
1 2 3 4 5 6 7 8 9 10 Median
72 76 62 43 81 72 63 77 72 73 72
Gender
Paretic Time since side stroke (years)
M F F F M F M M M M
left right left right right right left left right left
7 4 3 6 10 8 5 11 4 6 6
Topics in Stroke Rehabilitation 2015 VOL. 22
NO.
A single-group pre-test and post-test design with a 3-month follow-up was used. At baseline, clinical and laboratory measurements were taken on each subject. This was followed by 3 weeks of individual training four times a week. The measurements were repeated directly after the training period and again 3 months post intervention. The subjects were not allowed to participate in any other type of training, besides their regular daily-life activities from the start of the intervention until the follow-up test was completed. All measurements were blinded to the physical therapist leading the training. During the laboratory measurements, the subjects wore their regular socks and shoes, tight cycle-shorts, and nothing on the upper body (bra on females). The laboratory measurements always started with standing weight distribution. The subjects were instructed to stand in their preferred stance with one foot on each force plate imbedded in the floor. The distance between the heels was measured to ensure accurate reproduction in the follow-up measurements. Sway data from the force plates were then recorded for 10 seconds. Gait parameters were recorded while the subject walked for 10 trials at their preferred speed along 7 m-long walkway. After the laboratory measurements, each subject's ambulation (S-COVS) was assessed within 3 days at another location to limit the influence of fatigue on the measurements.
Gait parameters
The gait analyses was performed using an ELITE 2000 system (BTS Incorporated, Milan, Italy) composed of eight optoelectronic cameras recording kinematic data with a sampling frequency of 100 Hz and a calibrated space of 2 × 2 × 2 minutes. Twenty-two spherical reflective markers with a diameter of 15 mm were applied to the skin with double-sided tape over specific anatomical landmarks on lower limbs according to Davis's protocol.24 Gait cycle events were defined interactively with GAIT Eliclinic software (BTS Inc.) by defining heel strike, toeoff, and heel strike again from the kinetics and kinematics. Gait cycle time was normalized to 100% and temporal and spatial gait parameters were calculated in the software.
Standing weight distribution
Two 500 × 500 mm force plates (Kistler, Winterthur, Switzerland) were used to record three-dimensional ground reaction forces at a sampling frequency of 100 Hz. An index of asymmetry of the vertical force (Fz) between paretic and non-paretic leg was calculated for each trial25 as follows:
Fz ofpareticleg–perfectsymmetry (meanofFz ofbothlegs) perfectsymmetry (1)
M: male; f: female. 438
Procedure
6
Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
Zero percent indicates symmetry between sides and 100% indicates maximal asymmetry between sides. Positive values indicate greater loading on paretic side.
Ambulation
Ambulation was assessed with the Swedish Clinical Outcome Variables Scale (S-COVS).26 This scale consists of 13 motor tasks where the examiner rates from 1 (dependent) to 7 (normal) the level of performance in different motor tasks. The test permits measurement of activities regarding transportation, gait, postural control in sitting position, handling a wheel-chair, and arm/hand function. In this study, only items five to eight, representing ambulation variables, were assessed. These were human support, walking aids, endurance, and velocity. The individual scores were summarized (maximum 28). The S-COVS was run before, directly after and 3 months after training. It has been tested for inter-rater reliability for the total scores of the test and showed a 0.97 correlation coefficient: 0.93 for the specific items used in this study.26
Intervention
The training period consisted of four 1 hour sessions a week for 3 weeks. Every subject trained individually with the same physical therapist. The subjects’ symmetry training consisted of three tasks: 1) walking with wall-support (Fig. 1A): the subjects walked with the paretic side close to a wall. They were instructed to place the foot of the paretic leg on a 3- cm-wide and 10- m-long line running 20 cm from the wall. During the stance phase of the paretic leg, the subjects were instructed to shift their trunk so that the shoulder of the affected side touched the wall. Wearing regular shoes, they walked along the wall in this manner 10 times in three sets with 2 minutes rest between each set.
2) stepping up and down on a platform with wall-support (Fig. 1B): the subjects stepped, with the paretic side nearest the wall, up onto a 14- cm high, 90- cm long, and 35- cm wide platform. They had to step up and down walking forwards and then backwards, always with the paretic side against the wall. To be able to step and lift the non-paretic leg, the subjects had to transfer weight to the paretic leg so that the shoulder of the paretic side touched the wall. This task was executed 10 times in three sets with 2 minutes break between each set. 3) sitting down and rising from a chair with wall-support (Fig. 1C): the subjects sat on a chair without armrests, with the paretic side close to a wall. The paretic foot was positioned with a fairly large knee angle ( ≤ 90°) closer to the chair than the non-paretic foot. The subjects had to stand up and sit down while shifting body weight to the paretic side so that the shoulder of the paretic side touched the wall. They repeated the task 15 times in three sets with 2 minutes break between each set.
In the first session, the subjects were told to lean toward the wall during the stance phase on the paretic leg. This was to make them feel their weight bearing and the contact of the shoulder with the wall. The wall was used to create a somatosensory input for the subjects to know when they had executed the right weight transfer. Many subjects said they were afraid of falling when shifting their weight toward the paretic side, so the wall was a safety item preventing them from falling. As soon as the subjects had learned to control the weigh shift, they were asked to do the exercises without touching the wall. The goal was to walk without the wall as a touch reference or safety item. The progression from having the subjects lean toward the wall to not touching the wall was decided by the clinician as soon as the subjects managed to control their weight shift with the right amount of force to touch the wall, not missing it or hitting it too hard, and managed this in a 10 m session. The
Figure 1 The intervention: symmetry-training in three different tasks. Left panel (A): walking with wall-support. Middle panel (B): stepping up and down on a platform with wall-support. Right panel (C): rising from and sitting down on a chair with wall-support.
Topics in Stroke Rehabilitation 2015 VOL. 22
NO.
6
439
Andersson and Franzén Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke
Table 2 Gait parameters for paretic and non-paretic side, median (range)
Variable
Pre-
Post-
Velocity (m/s)
0.65 (0.2–1.1)
0.67 (0.2–1.2)
Cadence (steps/ min)
88.9 (47.5– 107.5)
88.4 (46.5– 111.8)
3-month follow-up 0.72 (0.3–1.2)
92.6 (57.0– 117.8)
Paretic Step length (mm)
431 (240–655)
Stride length (mm)
813 (561– 1263)
Stance time (ms)
709 (530– 1505)
835 (603– 1785)
739 (565– 1243)
Stance phase (% gait cycle)
57 (43–59)
56 (50–63)
56 (53–60)
Non-paretic Step length (mm)
440
452 (204–559)
871 (552– 1293)
Stride length (mm)
829 (585– 1311)
Stance time (ms)
878 (643– 1935)
400 (284–665)
883 (495– 1214)
795 (448– 1768)
T1–T2 P = 0.203 T1–T3 P = 0.037 T2–T3 P = 0.074 T1–T2 P = 0.203 T1–T3 P = 0.074 T2–T3 P = 0.241
464 (253–609)
T1–T2 P = 0.507
903 (504– 1348)
T1–T3 P = 0.575 T2–T3 P = 0.059 T1–T2 P = 0.139 T1–T3 P = 0.059 T2–T3 P = 0.444 T1–T2 P = 0.093 T1–T3 P = 0.959 T2–T3 P = 0.203 T1–T2 P = 0.047
428 (263–724)
T1–T2 P = 0.241
885 (263–724)
T1–T3 P = 0.332 T2–T3 P = 0.959 T1–T2 P = 0.721
734 (498– 1510)
Topics in Stroke Rehabilitation 2015 VOL. 22
Pre-
Post-
3-month follow-up
P-value
T1–T3 P = 0.169 T2–T3 P = 0.415 371 (222–620)
Variable
T1–T3 P = 0.878 T2–T3 P = 0.074 T1–T2 P = 0.005 T1–T3 P = 0.005
NO.
6
Stance phase (% gait cycle)
62 (52–76)
59 (43–74)
58 (49–72)
P-value T2–T3 P = 0.444 T1–T2 P = 0.037 T1–T3 P = 0.218 T2–T3 P = 1.000
Bold indicates P
