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Data for subjects with acute stroke obtained from Salbach et al. (2001); subjects, undergoing regular rehabilitation were evaluated 1-week post-stroke and 8 weeks later. Data for subjects with sub-acute stroke taken from Richards et al. (2004); subjects who received task-oriented physical therapy, were evaluated on average 52-days post-stroke and 8 weeks later. SRM that represents the average change score over a set period of time divided by the SD of that change.

*Comfortable walking speed measured over 5, 10 or 30 m. Maximum (max.) score for each measure shown in first column; values give mean or mean ± 1 SD.

Data for subjects with acute stroke obtained from Salbach et al. (2001); subjects, undergoing regular rehabilitation were evaluated 1-week post-stroke and 8 weeks later. Data for subjects with sub-acute stroke taken from Richards et al. (2004); subjects who received task-oriented physical therapy, were evaluated on average 52-days post-stroke and 8 weeks later. SRM that represents the average change score over a set period of time divided by the SD of that change.

*Comfortable walking speed measured over 5, 10 or 30 m. Maximum (max.) score for each measure shown in first column; values give mean or mean ± 1 SD.

according to whether the subjects walked <0.3 or S0.3m/s at baseline. Figure 1.1 compares the SRM values of the different measures in the two groups. Although the Barthel ambulation subscore remains the most responsive, the SRM is closer to the TUG and gait speed values in the faster walking group and conversely, the balance scale is more responsive in the slower walking group. These results are similar to those reported by Salbach et al. (2001) and Richards et al. (1995), in persons with acute stroke. Such results illustrate how floor and ceiling effects relate to responsiveness. When selecting a locomotor-related outcome measure it is important to consider the locomotor abilities of the persons to be evaluated. The Fugl-Meyer leg (FM-L) (Fugl-Meyer et al., 1975) subscale and the balance scale which rate the achievement of movement tasks, have a ceiling effect when evaluating higher-performing subjects. Conversely, walking speed can have a floor effect when evaluating subjects who walk at very slow speeds and require assistance

(Richards et al., 1995). The TUG also has a floor effect because many subjects cannot complete the test 2 months after stroke (Richards et al., 1999).

We must now question the classical recovery curve that has been defined by plotting change over time in clinical measures that have a ceiling effect. Thus, it is generally accepted that most recovery occurs in the first 6-week post-stroke when the effects of rehabilitation augment natural recovery. Thereafter, recovery slows but continues up to about 6-month post-stroke (Skilbeck et al., 1983; Richards et al., 1992; Jorgensen et al., 1995). With a continuous measure such as gait speed, however, recovery has been documented up to 2-year post-stroke (Richards et al., 1995). Moreover, a number of intervention studies in persons with chronic stroke have confirmed that recovery of function (Dean et al., 2000; Tangeman et al., 1990; Teixeira-Salmela et al., 1999, 2001; Salbach et al., 2004) and changes in brain organization (Liepert et al., 2000) occur beyond 6 months post-stroke.

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