In the fist study, we measured the proportions of participants who successfully

advanced to a higher ambulation classification, demonstrating a clinically meaningful

change in gait velocity. Forty-five percent of our total sample transitioned to a higher

classification; however, after baseline gait speed stratification, 63% of those walking

slower than 0.4 meters/second (m/s) and 38% walking between 0.4 and 0.8 m/s advanced

to the next ambulation classification. This indicates that those with the slowest speed, and

possibly the most severe mobility deficits, have the greatest potential for gains in gait

velocity.

 We also compared the differences in Stroke Impact Scale (SIS) measured

ADLs/IADLs, mobility, social participation, and physical functioning (SIS-16) dependent

on success or failure of advancement to a higher ambulation classification. After

controlling for a significant difference in age, all SIS scores for those with baseline gait

velocity less than 0.4 m/s were statistically different. In contrast, only the participation

score was significantly different for those with baseline gait velocity between 0.4 and 0.8

m/s. This suggests that a transition to the next ambulation classification is a clinically

meaningful change because it is related to increased function, particularly for the initially

more impaired stroke survivors. This is important as it validates the previous ambulation

classification developed by Perry and colleagues [9]. More importantly, it confirms the

use of ambulation classification in clinical and rehabilitation research settings. It indicates

that using ambulation classification is appropriate for goal setting and that increased gait

velocity is associated with highly significant increases in performance of activity and

participation.