© 2007 Foundation of Rehabilitation Information. ISSN 1650-1977 DOI: 10.2340/16501977-0026 J Rehabil Med 39 ORIGINAL REPORT J Rehabil Med 2007; 39: 170–174 GAIT IN HEMIPLEGIA: EVALUATION OF CLINICAL FEATURES WITH THE WISCONSIN GAIT SCALE Assunta Pizzi 1 , Giovanna Carlucci 1 , Catuscia Falsini 1 , Francesco Lunghi 2 , Sonia Verdesca 1 and Antonello Grippo 3 From the 1 Fondazione Don Carlo Gnocchi Onlus IRCCS Centro S. Maria agli Ulivi – Pozzolatico, Florence, 2 Department of Rehabilitation, Ospedale di Feltre, Belluno and 3 Department of Neurophysiopathology, “Azienda Ospedaliera Careggi”, Florence, Italy Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of changes in hemiplegic gait in post-stroke patients. Design: A prospective observational study. Subjects: Ten healthy subjects and 56 hemiplegic outpatients, more than 12 months post-stroke, consecutively admitted in a rehabilitation centre. Methods: Patients were videotaped while walking at a com- fortable speed. Quantitative and clinical gait parameters were derived from videotaped walking tasks at admission and at the end of a period of rehabilitation training. Qualitative fea- tures were assessed using the Wisconsin Gait Scale. Functio- nal status was rated through the modiied Barthel Index. Results: After training, the median Wisconsin Gait Scale score improved signiicantly (28 vs 26.5; p = 0.003). In parti- cular, “weight shift to paretic side” and patterns during the swing phase of the affected leg were improved. Gait velocity (0.3 vs 0.4 m/sec; p = 0.001) and stride length (77 vs 85 cm; p = 0.0002) increased signiicantly, whereas number of steps (25 vs 23; p = 0.004), stride period (2.5 vs 2.3 sec; p = 0.04), and stance period (2.1 vs 2 sec; p = 0.03) of the unaffected side were reduced. The Barthel Index score increased (71 vs 78; p = 0.005). Conclusion: The Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic sub- jects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring re- habilitation and monitoring results. Key words: hemiplegia, stroke, gait, rehabilitation, qualitative gait analysis, outcome. J Rehabil Med 2007; 39: 170–174 Correspondence address: Assunta Pizzi, Director of the Depart- ment of Neurorehabilitation, Fondazione Don C. Gnocchi ON- LUS, Centro S. Maria agli Ulivi Via Imprunetana, 124, IT-50020 Pozzolatico, Florence, Italy. E-mail: apizzi@dongnocchi.it Submitted February 2, 2006; accepted October 18, 2006. INTRODUCTION Cerebral vascular disease is a leading cause of gait impairment, resulting in long-term disability and handicap (1, 2). Walking recovery is a priority goal for most patients, since it widely determines patient’s status with respect to activities of daily living and quality of life (3). The gait of hemispheric stroke patients is characterized by several abnormal features (4, 5) such as asymmetry of stride time and length, reduced velocity, poor joint and posture control, muscle weakness, abnormal muscle tone, abnormal muscle activation patterns and altered energy expenditure, mostly affecting the paretic side (6–8). Several studies have investigated temporal and distance parameters of gait following stroke (1–13), but only a few are focused on clinical charac- terization of gait pattern. A detailed description of hemiplegic gait has been reported by Perry (14). Later, Rodriquez et al. (15) assessed eficacy of post-acute gait training program in hemiplegic patients, analysing both temporal and qualitative variables. For the visual quantiication of hemiplegic gait qua- lity the authors developed the Wisconsin Gait Scale (WGS), which was designed to identify hemiplegic gait deviations by examining weight-bearing joints and weight shift at each phase of gait. Hip, knee and ankle kinematics, inter-limb movement symmetry, balance/guardedness, assistive device use and selected gait parameters are examined and quantiied. WGS proved to have high intra-rater and inter-rater reliability when administered by physiatrists with neuro-rehabilitative expertise (16, 17). Recently, Turani et al. (18) studied WGS testing in 35 patients from 2 to 40 weeks post-stroke, concluding that this visual scale is valuable for assessing gait deviations and monitoring gait performance gains in patients with hemipa- resis. The WGS is a relatively new and unknown instrument, which is worth considering for clinical use. The aim of this study was to evaluate the usefulness of WGS in monitoring changes in gait features in patients with hemiplegia and to verify its possible use in rehabilitation departments. Using video- taping, we evaluated patients before and after a 4-week physio- therapy training analysing WGS and gait temporal parameters. In addition, for exploring whether gait quality is related to functional improvement, the functional impact of gait modiications was assessed through the modiied Barthel Index (BI) (19–22) and, more speciically, through its walking sub-score (9). METHODS Outpatients with hemiplegia following irst stroke, consecutively ad- mitted to a neuro-rehabilitation centre over a period of 15 months, were