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Stroke Research and Treatment
Volume 2014 (2014), Article ID 591013, 21 pages
http://dx.doi.org/10.1155/2014/591013
Review Article

Walking Adaptability after a Stroke and Its Assessment in Clinical Settings

1Department of Clinical and Applied Movement Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
2Brain Rehabilitation Research Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Roadd, Gainesville, FL 32608, USA
3Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32603, USA
4Department of Physical Therapy, University of Florida, P.O. Box 100154, Gainesville, FL 32610-0154, USA
5Brooks Rehabilitation, Jacksonville, FL 32216, USA

Received 15 April 2014; Accepted 6 June 2014; Published 28 August 2014

Academic Editor: Steve Kautz

Copyright © 2014 Chitralakshmi K. Balasubramanian et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.