Gait in stroke patients is influenced by upper limb functioning: a quantitative analysis correlating QuickDASH with Instrumented TUG and 10MWT

Loss of mobility after stroke is one of the main target of intervention in PRM and physiotherapy as motor impairment affects gait efficacy and upper limb function[1,2]: it is possible to observe a consensual improvement of these latter aspect throughout rehabilitation. Neural connections between upper and lower limb in gait are known[3,4] as well as the fact that modifications of upper limb movement during gait can affect gait parameters[5]. A recent review supports the inclusion of arm activity in addition to leg activity as a component of gait retraining after neurotrauma[6]. To the best of our knowledge, the association between upper limb disability and ability to move and walk in stroke patients has not been quantitatively studied: analysis of correlation between Instrumented TUG/10MWT tests and QuickDASH questionnaire can be a preliminary, easy to perform, and clinically suitable way to assess it. Research Question Do TUG/10MWT temporal and kinematic parameters and QuickDASH score correlate in stroke subjects? Methods A cross sectional study was performed in a tertiary referral sub-acute rehabilitation centre in Northern Italy. 20 stroke inpatients aged 66,53 (±7,60) were enrolled. Inclusion criteria were stable clinical conditions and no other neurological or musculoskeletal pathologies. Subjects evaluation consisted of motor and gait skills assessment by performing Timed Up & Go test and 10 Meter Walking Test, and upper limb disability evaluation by administering QuickDASH questionnaire. A wearable BTS G-Sensor IMU (Inertial Measurement Unit) was utilized to obtain a kinematic and temporal analysis of tests[7]. Spearman Correlation was carried out to assess the association between tests parameters and QuickDASH score (p<0.05). Results Correlation between QuickDASH score and TUG time to completion was found as well as for some sub-phases times: forward gait, mid turning and return gait. We also found a correlation with maximum rotation speed in end turning (tab1). With regard to QuickDASH and 10mWT, correlations were found for: time to completion, cadence, speed, gait cycle duration, stride length, % stride length and number of steps (tab2). Discussion The application of IMU wearable sensors to field tests has proven to be a useful, valid and user-friendly mode for assessing motor skills in stroke patients within clinical practice. Valuable correlations were demonstrated between the disability of upper limb and residual motor skills in stroke subjects: the higher the motor disability of the upper limb, the lower the performance in movement tests, and vice versa. These findings may open an alternative way to assess and thinking of the rehabilitation intervention in stroke patients, suggesting the possibility to enforce upper limb rehabilitation not just per-se, but in a wider and comprehensive program of motor skills recovery.