Analysis Acceleration/Deceleration Distance Walk Tests in Stroke Survivors

Study Overview
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Brief Summary
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Introduction: Gait speed is currently used to predict the future functional status of the patient or to evaluate the improvements produced by different neurorehabilitation treatments. There is no common agreement among researchers and clinicians as to the best distance required to accelerate and decelerate and the optimal distance to time walking speed in people in the chronic phase of stroke. Objectives: The main objective is to analyze whether the 6-meter walk test (6mWT) with one meter for acceleration and one for deceleration is optimal as well as 2 meters for acceleration and deceleration in the 10-meter walk test (10mWT) both at maximum and comfortable or usual speed for patients who have suffered a stroke in the chronic phase (> 6 months).Calculate the optimum acceleration and deceleration distance in the 6mWT and 10mWT tests at comfortable speed and at fast speed. The secondary objective is to evaluate whether the 10-meter walk test (10mWT) is comparable to the 6mWT for a correct measurement of gait in patients who have suffered a stroke in chronic phase (> 6 months). Methods: A cross-sectional observational study will be performed. The walking speed will be measured using the OptiTrack optical motion capture system consisting of 8 PrimeX 13 cameras and Motive 2.0 capture and analysis software (Natural Point Inc. Corvallis OR USA).The results of the 6mWT with a one-meter zone for acceleration and a one-meter zone for deceleration will be compared with the 10-meter gait test (10mWT) with 2 meters for acceleration and 2 meters for deceleration. The patient will have 8 markers applied to different parts of the body. The two tests are performed first at a comfortable gait and second at the fastest gait that the patient can safely perform. There will be 3 repetitions for each of the tests. The patient will be randomized to start with either the 6mWT or the 10mWT test. All tests will be performed on the same day. Discussion: This study will shed light on what is the optimal distance required for acceleration and deceleration in the 6mWT and 10mWT walking tests at comfortable and fast speed and whether the two tests are comparable.

Detailed Description
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Introduction Stroke is a worldwide health problem and in the last two decades, the number of survivors has increased. One third of them present an inability to walk in the community and the others present different gait disturbances such as slow speed and lack of stamina to allow them to return to pre-stroke activity levels. Returning home and community ambulation is a primary rehabilitation goal for many stroke survivors. Ambulation ability is commonly correlated with gait speed. It is commonly used as an objective measure of functional mobility. and is strongly associated with fall risk, quality of life, and gait independence. In addition, it has been shown to have the potential to predict an individual's future functional impairment and long-term survival. It is recommended to use gait speed as a vital sign of health. Improvements of 0.1 meters/second or more have been found to predict good health, whereas decreased walking speed has been associated with worse health outcomes. Ambulation ability predicted by walking speed is a reliable method for classifying the functional status of stroke survivors. To date, the 10-meter comfort walk test (10mWT) is a measure that has demonstrated excellent reliability and construct validity throughout the post-stroke rehabilitation process and is sensitive to change in that population. But different researchers disagree on how to run the test. Some perform the test in a 14-meter corridor. A disadvantage may be that an ambulatory or home medical practice setting may have limited space and/or terrain with different obstacles, such as furniture, to walk on. Others perform it in 10 meters and time the 6 meters, leaving 2 meters to accelerate and another 2 meters to decelerate. To authors' knowledge, have not found any study in a gait laboratory, with with motion capture system with cameras and markers, assessing whether this distance is correct for accelerating and decelerating in these individuals. An alternative option to the 10mWT could be the 6mWT, which is included in the Short Physical Performance Battery (SPPB). SPPB is one of the most widely used tools in the investigation of elderly people and as a predictor of functional capacity after stroke. This test consists of three tests: balance, 4mWT (no zone for acceleration/deceleration) and 5 times sitting and standing. The 4mWT is increasingly used as an independent measure and is an established marker of exercise capacity in the elderly. To authors' knowledge there are four studies correlating 4mWT with 10mWT: three studies in elderly population only was evaluated in women, one in lower extremity surgery, and one in pulmonary pathology. Some authors used 5 meters of acceleration and deceleration for the 10mWT test, i.e. they needed a 20-meter corridor and 2 meters for the 4mWT they needed an 8-meter corridor. Other author did not use zones for acceleration and deceleration. Another used 2 meters of acceleration and deceleration for the 10mWT and for the 4mWT. Other author used 2 meters of acceleration and deceleration for the 10mWT and 3 meters of acceleration and deceleration for the 4mWT in healthy individuals, with various pathologies and in elderly people. In the scientific literature there is no common agreement on how to name the gait tests. Some call the test by the meters timed and others call it by the meters that are necessary to perform the test, regardless of the acceleration and deceleration zone. The authors have decided to name the tests by the meters necessary to carry out the test. Therefore the 6mWT test will be 6 meters in total, which are needed to perform the test and 4 meters are timed and 10mWT also the meters needed regardless of the acceleration and deceleration zone, therefore 6 meters are timed. This discordance in the protocols in gait speed tests has led to confusion about which is the optimal method of measurement. To our knowledge, there is only one study (Ng,2016) that proposes the optimal zone for acceleration/deceleration for the performance of the 5-meter walk test, concluding that one meter was sufficient, but no objective analysis such as optical cameras was performed. This area of knowledge needs more research. Procedure and Instruments Gait speed will be measured using the OptiTrack optical motion capture system consisting of 8 PrimeX 13 cameras and Motive 2.0 capture and analysis software (Natural Point Inc. Corvallis OR USA). Anatomical landmarks are tracked in space by applying a 10 mm diameter spherical adhesive marker at different points on the body. These markers are used to accurately record how the participant walks. Two will be placed at the level of the thorax, one in front on the chest at the level of the sternal manubrium and one posterior at the level of T7. Two more will be placed in the pelvis, one in the anterior area at the midline and the other at the level of S1 and finally two in each foot, at the level of the 5th metatarsal and in the center of the heel. There are different cameras installed in the laboratory that use the software to record the positions of the markers during the test. To carry out the 10mWT test, a 10-meter flat, unobstructed, hard-floor path was identified in the laboratory. Two meters will be provided for the acceleration zone and 2 meters for deceleration and will be marked with tape and four cones. A walk will be demonstrated to each participant prior to the start of the test, but the participants themselves will not perform a practice walk.The following standardized instructions will be given to individuals: This is our walking corridor. I want you to walk to the other end of the corridor at a comfortable speed, as if you were walking down the street. When you have passed the other end of the treadmill and the cone, you stop. With the instructions of ready, set, go, and you will begin walking. Participants, must wear comfortable walking shoes, and will start with their toes behind a starting line. They will be allowed to use assistive devices (canes and/or foot-ankle orthoses) to ensure safety, if used for activities of daily living. For the 6mWT test, 1 meter of acceleration zone and 1 meter of deceleration zone will be provided and will be marked with tape and 4 cones. The same instructions as for the 10mWT will be given to the individuals, with the new shorter distance.

Official Title
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Analysis of the Optimal Distance for Acceleration and Deceleration in Gait Speed Tests With Motion Capture System in Chronic Stroke Survivors. Cross-sectional Observational Study

Conditions
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Stroke, Chronic Stroke

Intervention / Treatment
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* Diagnostic Test: 6 and 10 meters walking test 6-MeWT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stroke survivors in chronic phase > 6 months Have preserved cognitive ability: Achieve a score equal to or greater than 25 points on the Montreal Cognitive Assessment test. Have the ability to walk on a flat surface of at least 10 meters, with or without aid. Exclusion Criteria: A history of lower extremities injury or surgery A history of botulinum injection within 3 months A history of inflammatory arthritis A history of inflammatory myopathy or peripheral nervous disease A history of other neurological disease as a Parkinson, spinal cord etc.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: 6 and 10 meters walking test 6-MeWT|A 10-meter and other 6-meter flats pathways were identified. Two-meter will be provided for the acceleration zone and two-meter for deceleration for 10-MWT. One meter to acceleration and another to deceleration. The participants will perform 3-time to normal speed and 3-time faster for 10-meter and 6-meter for both.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceleration/deceleration distance in 6mWT at comfortable speed | Distance time that an individual needs to reach their average gait speed | 15 minutes | 
| Acceleration/deceleration distance in 10mWT at comfortable speed | Distance time that an individual needs to reach their average gait speed | 15 minutes | 
| Acceleration/deceleration distance in 6mWT at fast speed | Distance time that an individual needs to reach their average gait speed | 15 minutes | 
| Acceleration/deceleration distance in 10mWT at fast speed | Distance time that an individual needs to reach their average gait speed | 15 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait speed in 6mWT | Gait speed is the time one takes to walk a specified distance on level surfaces over a short distance. | 15 minutes | 
| Gait speed | Gait speed is the time one takes to walk a specified distance on level surfaces over a | 15 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gait speed, comfortable gait speed, acceleration distance, walking test, 10mWT, 6mWT, fast speed, 10 meters walk test, 4 meters walk test, deceleration distance