# The Relationship between Gait Velocity and Walking Pattern in Hemiplegic Patients
## 2 Materials and Methods
### Assessment  
Each patient underwent a clinical evaluation where demographic parameters and body mass index (BMI) were recorded and several scales were used: Visual Analogic Scale (VAS) for pain, paretic side Motricity Index (MI), Barthel Index (BI) and Nottingham Extended ADL Scale (NEAS). To record the pain, a Visual Analogue Scale (VAS) was chosen as an instrument that can measure a characteristic or attitude that ranges across a continuum of values [18]. The assessment of pain in rehabilitation is one of the central clinical features, depending on its correlation to the level of patients' activities and limitations, and it is widely used as an outcome target in both clinical practice and treatment efficacy [19]. The VAS for chronic pain has demonstrated sensitivity to changes in pain assessed at different times and to the variables that increase or decrease its intensity, presents a high test-retest reliability and repeatability and finally shows a strong association with activities influenced by pain. To test the hemiparetic patients' motor impairment, the Motricity Index (MI) was selected for its feasible application [20]. MI is a brief measure of motor function and in the literature was effective as predictor of mobility outcome poststroke [20]. It consists of testing the muscle strength in upper and lower limbs. We used only the section for the lower limb, representing the main focus of our study. The three movements checked were hip flexion, knee extension and ankle dorsiflexion [20]. To graduate muscle force, the Medical Research Council scale [21] was used, an ordinal six points scale (0 no movement to 5 normal power), then the scores were converted to the corresponding motricity score and summed and added, resulting in a total value ranging from 0 (complete paresis) to 100 (normal strength) [20]. MI has high reliability as measure of muscle strength, is simple to apply and does not require special training or equipment [22]. The Barthel Index (BI) is a common scale used to quantify the poststroke patient's disability and impairment in ADL function [23; 24; 25]. The range scoring is from 0 to 100 (maximum disability to high independence) and each item assesses different features of ADL such as bowel and bladder control, grooming, toilet use, feeding, dressing, chair/bed transfers, walking, climbing stairs and bathing [26]. It represents a good outcome measure for functional evaluation and is one of the most recommended measures, showing good results in test-retest reliability [22; 23; 26]. The Nottingham Extended ADL scale (NEAS) is composed of four subsections with defined subscales that evaluates poststroke patient's mobility, household ability and leisure activity [27]. NEAS is a measure of ADL that goes beyond basic self-care as BI [28]. The scale has 22 items, each one having four possible answers representing the help needed during the specific activity (from \"not at all\"--0 to \"on my own\"--3) [27]. The final score (range 0-66) represents an instant frame of disability level and values of 44 or higher indicate no need for assistance in more complex self-care abilities [22]. NEAS was developed to best assess poststroke patients' ADL during the follow up after discharge from hospital [28; 29]. The goniometric measurements of lower limb active range of motion (aROM) for hip (flexion, extension, abduction, adduction), knee (flexion, extension) and ankle (dorsiflexion) joints was also performed. Lower limb muscular strength was measured for the paretic and unaffected limb using a hand-held dynamometer (IMADA Muscle Force Measurement Device). The iliopsoas was tested as hip flexor, the gluteus maximus as hip extensor, the gluteus medius as hip abductor, the quadriceps as knee extensor, the hamstring and semitendinosus as knee flexors and the tibialis anterior as ankle dorsiflexion.