Recuperación de la marcha durante el primer año tras el ictus medido a través de acelerometría

Resumen

INTRODUCTION: The high incidence, chronic sequelae and economic impact of stroke highlights the need to develop a neurological physiotherapy in the community, according to financial, social and health purposes. Physical therapy gait assessment has commonly been performed in clinical standardized settings, with subjective tools. Accelerometers offers the possibility of monitoring human movement objectively in the community, with some advantages including the low-cost, high accuracy and reliability and their small size which enables subjects to walk relatively unrestricted. In spite of the benefits of accelerometry, only a few studies have comprehensively examined different aspects of walking behavior among stroke patients. OBJECTIVES: The purpose of this study was to describe the course of different dimensions of walking behaviour, in terms of amount, distribution and quality, over a period of one year following stroke, using accelerometry; to explore the mutual relationships between main outcomes measures, and to compare the patient data one year after stroke with a healthy group. METHODS: Design: related to the first objective, we performed a one-year follow-up cohort study, in relation with the second objective the design was a correlational study and, with regard to the third objective, we used a repeated-measures design. Participants: A total of 23 stroke patients, recruited with a non-probability convenience sampling, and 20 age-matched healthy subjects were included in the study. Intervention: Accelerometer assessments were made in the participants’ daily environment for 8 h/day during the 1st (T1), 12th (T2) and 48th (T3) weeks after stroke, and at one time-point in healthy subjects. Main outcomes measures: percentage of time walking, time upright, time sitting, time lying and sedentary time (amount aspect); mean duration and number of walking periods, walking coefficient of variation and sedentary exponent (distribution aspect), step and stride regularity, step and stride symmetry, step-time ratio and walking speed (quality aspect). RESULTS: Time walking, time upright and number of walking bouts increased during T1 and T2 (p<0.01), and then levelled off (p>0.58). The rest of distribution variables showed no significant improvements (p>0.30) during all phases. Stride regularity longitudinal, gait symmetry longitudinal and gait speed increased significantly from T1 to T3. Moderate to high correlations were found between upright time and number of walking periods; walking time and mean duration of walking periods; walking time and gait speed and between step regularity and gait speed. At T3, amount and distribution variables (except for time lying and sedentary time) reached the level of the healthy group, but significant differences remained (p<0.02) in step regularity and gait speed. CONCLUSIONS: In this cohort, different outcomes of walking behavior, represented by amount, distribution and quality parameters of gait, showed different patterns and levels of recovery during the first year post-stroke. Describing these aspects of walking may help physical therapists to understand stroke patients’ motor problems, to establish tailored therapeutic objectives and to choose the appropriate dose and treatment in patients’ natural environment.