Steps after stroke - Capturing ambulatory recovery

Background and Purpose - Nearly two thirds of stroke survivors have deficits impairing ambulatory recovery. Conventional mobility outcome measures such as timed walks and functional independence measure (FIM) do not quantify free-living ambulatory behavior. This study compared step activity monitoring (SAM) with established instruments to assess ambulatory recovery across the outpatient subacute stroke rehabilitation phase. Methods - We measured FIM mobility subscale, SAM-derived daily steps, Stroke Impact Scale (SIS) mobility scores, and timed walks in 11 subjects after discharge from inpatient rehabilitation and again 3 months later. Results - Significant improvement was measured in free-living step activity ( mean gain 80%; P = 0.001) but not with timed walks ( P = 0.4), FIM ( P = 0.08), or SIS mobility scales ( P = 0.3). Conclusions - Microprocessor-linked SAM is a sensitive indicator of ambulatory recovery that measures improvements not captured by other conventional outcome instruments.