%0 Journal Article
%T Walking Adaptability after a Stroke and Its Assessment in Clinical Settings
%A Chitralakshmi K. Balasubramanian
%A David J. Clark
%A Emily J. Fox
%J Stroke Research and Treatment
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/591013
%X Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke. 1. Introduction Approximately, 600.000 individuals incur a stroke each year and stroke is the leading cause of long term disability in the United States [1, 2]. Walking function in those who have sustained a stroke may range from complete dependence to independent walking ability. During the first week after a stroke, only a third of persons are able to walk unaided [3] but at 3 weeks or at hospital discharge 50¨C80% of survivors can walk unaided [4, 5] and by 6 months approximately 85% of stroke survivors are able to walk independently without physical assistance from another person [6]. Interestingly, while up to 85% of individuals with a stroke regain independent walking ability [6¨C8], only about 7% of persons discharged from inpatient rehabilitation could manage steps and inclines and walk the speeds and distances required to walk competently in the community [8¨C10]. Walking in everyday life necessitates walking adaptability, which is the ability to modify walking to meet behavioral task goals and demands of the environment [11¨C13]. The ability to adapt walking is one component of a tripartite
%U http://www.hindawi.com/journals/srt/2014/591013/