Background: Recently, a new method of dysphagia rehabilitation using Kinesio taping (KT) has been attempted and demonstrated an immediate increase in the activation of the suprahyoid muscle during swallowing in healthy adults. Objectives: To investigate the effect of dysphagia rehabilitation using KT on the thickness change of the suprahyoid muscle in patients with dysphagia after stroke. Design: Two-group pre-post design. Methods: In this study, 20 patients with dysphagia after stroke were enrolled and assigned to the experimental and control groups. The experimental group applied KT to the front of the neck and repeatedly swallowed against the tension of the tape. On the other hand, the control group performed repeated swallowing without applying KT. Patients in both groups had swallowed 50 times a day/5 times a week for 4 weeks. For evaluation, the volume of the geniohyoid, mylohyoid, and digastric muscle was measured before and after the intervention using portable ultrasound equipment. Results: As a result of comparing the two groups after the intervention, the experimental group showed more volume increase in mylohyoid (P<.05) and digastric muscle (P<.05) than the control group. Conclusion: This study proved that suprahyoid muscle resistance exercise using KT is effective in increasing the volume of the suprahyoid muscle.

Background: Therapeutic climbing training, which originated in Germany, is a wall-hanging rock climbing-based therapy to increase the body's coordination through movement of the upper and lower limbs against gravity. However, there are no studies examining the effectiveness of therapeutic climbing training to treat balance and gait ability in patients with chronic stroke. Objectives: To investigate therapeutic climbing training program on balance and gait in patients with chronic stroke. Design: Pretest-posttest control group design. Methods: Fourteen patients with chronic hemiplegic stroke participated. Participants were randomized into the therapeutic climbing training group (TCTG, n=7) and the standard rehabilitation program group (SRPG, n=7) group. All subjects participated in the same standard rehabilitation program consisting of 60 minutes 5 times a week for 6 weeks. TCTG participated additionally in the therapeutic climbing program consisting of 30 minutes sessions 3 times a week for the same 6 weeks. Berg balance scale (BBS), Gaitview Measure, Timed up and go test (TUG) were measured. Results: In the TCTG, revealed a statistical difference in BBS between the groups; in the difference of plantar pressure ratio in the static standing position revealed a statistical difference between the groups after training; the balance ability in the one-leg standing tests increased significantly; the time in TUG decreased significantly after training in both groups; The changes in the difference of dynamic plantar pressure ratio were reduced significantly in the TCTG. Conclusion: Therapeutic climbing training contribute to improve balance and walking function in patients with chronic stroke.

Background: Patients with stroke have core muscle weakness and limited rib cage movement, resulting in restrictive lung disease. Objectives: To examine the comparison of effects of rib cage joint mobilization combined with diaphragmatic breathing exercise and diaphragmatic breathing exercise on the pulmonary function and chest circumference in patients with stroke. Design: A cluster randomized controlled trial. Methods: Twenty-four patients were randomly assigned to an experimental group (rib cage joint mobilization combined with diaphragmatic breathing exercise group) and control group (diaphragmatic breathing exercise group). Patients in the experimental group underwent rib cage joint mobilization for 15 min and diaphragmatic breathing exercise for 15 min. The control group underwent diaphragmatic breathing exercise for 30 min. Both groups underwent exercise thrice a week for 4 weeks. The pulmonary function and chest circumference were measured using the MicroLab spirometer and a tape measure, respectively. Results: After the intervention, the pulmonary function and chest circumference significantly improved in both groups. These improvements were significantly higher in the experimental group than those in the control group. Conclusion: Rib cage joint mobilization combined with diaphragmatic breathing exercise improves pulmonary function and chest circumference in patients with stroke.

Background: Stroke patients experience multiple dysfunctions that include motor and sensory impairments. Therefore, new intervention methods require a gradational approach depending on functional levels of a stroke patient’s activity and should include cognition treatment to allow for a patient’s active participation in rehabilitation. Objects: This study investigates the effect of integrated revision of electrical sensory stimulation, which stimulates somatosensory and action observation training, which is synchronized cognition intervention method on stroke patients’ functions. Methods: Twenty-one stroke patients were randomized into two groups. The two groups underwent twenty minutes of intervention five times a week for three weeks. This study used an electromyogram to evaluate symmetric muscle activation of lower extremities and muscle onset time when performing sit to stand before and after intervention. A weight-bearing ratio was used to evaluate the weight-bearing of the affected side in a sit to standing. To evaluate sit to stand performance ability, this study performed five timed sit to stand tests. Results: The two groups both showed statistically significant improvement in muscle onset time of lower extremity, static balance ability in a standing position, and sit to stand performance after the intervention (p < 0.05). In addition, the action observation and synchronized electrical sensory stimulation group showed significant improvement in symmetric muscle activation of lower extremities and weight–bearing ratio of the affected side (p < 0.05). Conclusion: action observation and synchronized electrical sensory stimulation (AOT with ESS) can have positive effects on a stroke patient’s sit to stand performance, and the intervention method that provides integrated AOT with ESS can be used as new nervous system intervention program.

Background: Stroke patients have reduced trunk control compared to normal people. The ability to control the trunk of a stroke patient is important for gait and balance. However, there is still a lack of research methods for the characteristics of stroke control in stroke patients. Objects: The aim of this research was to determine whether trunk position sense has any relation with balance and gait. Methods: This study assessed trunk performance by measuring position sense. Trunk position sense was assessed using the David back concept to determine trunk repositioning error in 20 stroke patients and 20 healthy subjects. Four trunk movements (flexion, extension, lateral flexion, rotation) were tested for repositioning error and the measurement was carried out 6 times per move; these parameters were used to compare the mean values obtained. Subjects with stroke were also evaluated with clinical measures of balance and gait. Results: There were significant differences in trunk repositioning error between the stroke group and the control group in flexion, lateral flexion to the affected side, lateral flexion to the unaffected side, rotation to the affected side, and rotation to the unaffected side. Mean flexion error: post-stroke: 7.95 ± 6.76 degrees, control: 3.32 ± 2.27; mean lateral flexion error to the affected side: 6.13 ± 3.79, to the unaffected side: 5.32 ± 3.15, control: 3.57 ± 1.92; mean rotation error to the affected side: 8.25 ± 3.09, to the unaffected side: 9.24 ± 3.94, control: 5.41 ± 1.82. There was an only significant negative correlation between the repositioning error of lateral flexion and the Berg balance scale score to the affected side (–0.483) and to the unaffected side (–0.497). A strong correlation between balance and gait was found. Conclusion: The results of this study indicate that stroke patients exhibit greater trunk repositioning error than age-matched controls on all planes of movement except for extension. And lateral flexion has correlation with balance and gait.

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

Background: Recently, the kinesiology taping (KT) method was reported to be effective in improving walking ability in foot drop patients after stroke, but the clinical basis is still unclear. Objectives: The KT method was compared with ankle-foot orthotics (AFO) to investigate gait ability in foot drop patients after stroke. Design: Crossover study design. Methods: In this study, 11 stroke patients with foot drop participated. Walking ability of all subjects for both conditions (KT and AFO) was measured using the GAITRite system. The order of application of the two conditions was determined randomly by drawing lots. Wilcoxon signed-rank test was used to compare walking ability between the two conditions. The level of statistical significance was set at P<.05. Results: There were no significant differences between the KT and AFO methods in terms of velocity, cadence, step length, and stride length (P>.05, all). Conclusion: This study recommends KT as an alternative to the AFO, since KT provides evidence of preventing of foot drops and improving gait ability in stroke patient.

Background: Kinesiology taping (KT) is a method that helps immediately increase muscle activation, strength and joint stability by being attached to various skeletal muscles and structures of the body. Objectives: To investigate the effect of KT applied below the hyolaryngeal complex on the movement of the hyolaryngeal complex during swallowing in patients with dysphagia after stroke. Design: One-group, pre-post design. Methods: Twenty individuals with dysphagia after stroke participated in this study. KT was applied to the sternum and both clavicles from the hyolaryngeal complex. We analyzed the motion of the hyolaryngeal complex during swallowing with and placebo KT and KT using the Image-J software with videofluoroscopic swallowing study. In addition, a 0-to-10 numerical rating self-report scale was used to check the required effort and resistance felt during swallowing. Results: KT condition showed that the anterior and superior movement of the hyoid bone during swallowing was significantly lower than placebo KT (P<.05, all). Also, KT condition showed that the anterior and superior movement of the larynx during swallowing was significantly lower than placebo KT (P<.05, all). In result of statistical comparison between KT group and placebo KT group, the KT group showed significantly higher self-report scale score than the placebo KT group in terms of two category; the required effort and resistance felt (P<.05, all). Conclusion: This study demonstrated that KT applied below the hyolaryngeal complex inhibits the anterior and superior movement of hyoid bone and larynx during swallowing of patients with dysphagia after stroke.

Background: Weakness of the trunk muscles decreases the trunk control ability of stroke patients, which is significantly related to balance and gait. Objectives: To compare the impact of diagonal pattern self-exercise on an unstable surface and a stable surface for trunk rehabilitation on trunk control, balance, and gait ability in stroke patients. Design: Nonequivalent control group design. Methods: Twenty four participants were randomized into the experimental group (diagonal pattern self-exercise while sitting on an unstable surface, n=12) and the control group (diagonal pattern self-exercise while sitting on a stable surface, n=12). All interventions were conducted for 30 minutes, three times a week for four weeks, and the trunk impairment scale (TIS), berg balance scale (BBS), functional gait assessment (FGA), and G-walk were measured. Results: All groups indicated significant increases in all variables (TIS, BBS, FGA, cadence, speed, stride length) after four weeks. The TIS, BBS, FGA, cadence, gait speed, and stride length group-by-time were significantly different between the two groups. Conclusion: We found that, in stroke patients, diagonal pattern self-exercise on an unstable surface is a more effective method for improving trunk control, balance, and gait ability than diagonal pattern self-exercise on a stable surface.

목적 : 본 연구는 스마트 글러브를 이용한 가상현실 기반의 상지재활훈련이 뇌졸중 환자의 상지기능, 상지의 근 활성도, 일상생활 활동과 삶의 질에 미치는 효과를 분석하고자 한다. 연구방법 : 선착순 무작위 대조 실험연구 방식으로 연구를 진행하였다. 의료연구협의회 지표(medical research council scale), 한국판 간이정신상태검사(Korean version of Mini-Mental State Examination; MMSE-K)로 대상자를 선별하여 뇌졸중 환자 31명을 무작위로 스마트 글러브를 이용한 가상현실 기반의 상지재활훈련군과 일반적 작업치료군으로 나눈 뒤, 주 5회 하루 30분씩 총 25회기 동안 실험을 진행하였다. 중재 전ᆞ후 비교 분석을 하기 위해서 뇌졸중 상지 기능평가(Manual Function Test; MFT), 표면 근전도 검사(Surface Electromyography; EMG), 한국판 수정된 바델지수(Korean version of Modified Barthel Index; K-MBI), 뇌졸중 영향 척도 3.0(Stroke Impact Scale 3.0; SIS)을 사용하였다. 결과 : 첫째, 실험군과 대조군에서 상지의 기능향상(MFT)이 있었고, 실험군에서 위팔노근의 근 활성도에 유 의한 향상이 있었다. 둘째, 일상생활활동에서는 실험군과 대조군에서 유의한 향상을 보였다. 셋째, 삶의 질 에서는 실험군에서 유의한 향상이 있었다. 결론 : 스마트 글러브를 이용한 가상현실 기반 상지재활훈련은 뇌졸중 환자의 상지기능, 근 활성도, 일상생활 활동과 삶의 질을 향상하는 효과적인 작업치료 방법이다.

Background: Multifaceted approaches will be needed, such as global synkinesis (GS) achieve functional improvements in the arms of stroke patients from involuntary movements during exercise. Objective: To identify changes in arm GS and muscle activity, functional evaluation and the correlation with variables through action observation training, combined with functional electrical stimulation (FES), thereby verifying the effect on stroke patients. Design: A quasi-experimental study. Methods: The subjects of this study were 20 stroke patients who were divided into two groups: Control group (n=10) and experimental group (n=10). Before the intervention, arm GS and muscle activity were measured using surface electromyography (EMG), and arm function was evaluated using the Fugl– Meyer Assessment (FMA) scale. At the end of the intervention, which lasted 4-wk, arm GS and muscle activity were measured again using the same scale. Results: There was a decrease statistically significant difference in GS during the bending action in experimental group (P<.01). Both groups showed a significant difference increased only in the activity of the anterior deltoid (AD) and biceps brachii (BB) (P<.05). The results of the arm functional assessment revealed a significant difference increase in both groups (P<.05). In the between-group comparison, there was a significant difference decrease in GS during the bending action (P<.05). Only the muscle activity of the AD and BB were significantly increase different (P<.05). There was a significant betweengroup difference increase in the arm functional assessment (P<.05). There was a positive correlation between GS and muscle activity on the FMA in the control group (r=.678, P<.05). In experimental group, GS during the bending arm action exhibited a negative correlation (r=-.749, P<.05), and the muscle activity of the AD and BB showed a positive correlation (r=.701, P<.05). Furthermore, in experimental group, the activity of the extensor carpi radialis increased, and the activity of the flexor carpi radialis decreased, which exhibited a negative correlation (r=-.708, P<.05). Conclusion: These results suggest that brain plasticity could be more efficiently stimulated by combining surface stimulation in the affected arm of stroke patients.

Background: Motor imagery is the mental representation of an action without overt movement or muscle activation. However, few previous studies have demonstrated motor imagery training effects as an objective assessment tool in patients with early stroke. Objective: To investigate the effect of motor imagery training on Somatosensory Evoked Potentials (SSEP) and upper limb function of stroke patients. Design: A quasi-experimental study. Methods: Twenty-four patients with stroke were enrolled in this study. All subjects were assigned to the experimental or control group. All participants received traditional occupational therapy for 30 minutes, 5 times a week. The experimental group performed an additional task of motor imagery training (MIT) 20 minutes per day, 5 days a week, for 4 weeks. Both groups were assessed using the SSEP amplitude, Fugl-Meyer assessment of upper extremity (FMA UE) and Wolf motor function test. Results: After the intervention, the experimental group showed significant improvement in SSEP amplitude and FMA UE than did the control group. Conclusion: These findings suggest that the MIT effectively improve the SSEP and upper limb function of stroke patients.

Background: The foot drop stimulator is designed to improve the walking ability of foot drop in patients after stroke, however, studies on clinical effects are still lacking. Objective: To investigate the effect of a foot drop stimulator on the walking and balancing abilities of foot drop patients after a stroke. Design: One-Group (Pretest-Posttest) Design. Methods: All subjects walked in all three conditions: foot drop stimulator (FDS) ankle foot orthosis (AFO) and barefoot. Primary outcome measures were assessed for walking and balance using a 10-m walking test (10MWT) and a timed up and go test (TUG). Secondary outcome measures consisted of a brief user interview, and the patients recorded the advantages and disadvantages of each condition. Results: FDS, AFO, and barefoot conditions showed a statistically significant difference in 10MWT and TUG (P<.001) as a result of comparing three conditions. FDS and AFO were significantly different from the barefoot condition as post-hoc results; however, there was no significant difference between the two conditions (P>.05). Conclusion: In this study, the foot drop stimulator contributed to improving the balance ability, and the walking ability was similar to the effect of the anklefoot orthosis.

Background: Ankle instability usually occurs after stroke, and contributes to unsafe walking and associated risk of falling in the affected patients. Objective: To investigate the effects of kinesiology taping (KT) on gait and balance ability (center of pressure, CoP) in patients with ankle instability after stroke. Design: One group, pre-post design. Methods: A total of 11 patients with ankle instability after stroke were enrolled. In all subjects, the gait and balance ability were assessed under 2 conditions: KT and barefoot. Gait and balance ability was assessed using GAITRite system and FDM-S platform. Results: Comparison between KT and barefoot condition, KT condition was significantly higher in velocity, cadence, step length, and stride length than barefoot condition (P<.05). KT condition was significantly lower in CoP path length and sway speed than barefoot condition (P<.05). Conclusion: KT indicated potential as a helpful method for walking and balancing ability in patients with ankle instability after stroke. Therefore, this study recommends KT as an option applicable to the stroke with ankle instability.

Background: Health-related quality of life (HRQOL) is a construct of quality of life relevant to health. HRQOL can be measured multiple ways including self-perceived interpretation of one’s health status. Research has shown value in understanding self-perceived or person-centered HRQOL. Thus, these types of assessments have been integrated into health care systems, used to help patients set personal goals and to determine treatment success. The purpose of this study was to describe the group, examine the relationship between HRQOL and functional independence, and then determine the impact of standard care on the HRQOL (index and visual analog scale [VAS]). Methods: Retrospective clinical observation study. Descriptive statistics used to describe the stroke sample. Comparison was performed to explore the correlation between the EuroQol 5-Dimensions Questionnaire (EQ-5D) and the Functional Independence Measure (FIM) at admission and discharge. Paired-samples t-test was conducted to evaluate the impact of standard therapy on HRQOL on EQ-5D. Results: n=1325; mean age of 72 years (SD=13.28) and 65% females. A weak, positive correlation found at admission (r=.15, n=1325, p<.000) and discharge (r=.04, n=1325, p<.000). A paired-samples t-test revealed a statistically significant increase in HRQOL index and VAS scores (p’s<.000) overtime, with a large effect size (η2=.74 and .70), respectively. Conclusion: A weak relationship was present between HRQOL and functional independence, thus suggesting these assessments should be used independent of each other. Statistically significant change in scores suggest improvement in HRQOL overtime, supported by large effect sizes and mean scores higher than the minimal important difference range.

목적 : 본 연구는 지역사회에 거주하여 작업치료를 받고 있는 뇌졸중 환자를 대상으로 지역사회 참여정도가 삶의 질에 미치는 영향에 대하여 알아보고, 상관성 및 인과관계에 따른 설명력을 알아보고자 한다. 연구방법 : 뇌졸중 환자 117명을 대상으로 하였다. 지역사회 참여지표를 통하여 지역사회 참여도를 조사 하였고, 뇌졸중 환자의 삶의 질 측정을 사용하여 삶의 질을 평가하였다. 삶의 질과 사회참여와의 상관관계를 분석하기 위하여 피어슨 상관분석을 실시하였으며, 그에 따른 인과관계를 알아보기 위하여 회귀분석을 실시하여 분석하였다. 결과 : 지역사회 참여에 영향을 미치는 요인으로 질병의 정도가 심할수록 참여정도가 낮았으며, 선거에 참여할수록 참여정도가 높았다. 삶의 질에 영향을 미치는 요인으로 참여 주도권, 사회적 유대 및 관계, 참여의 의의가 높을수록 사회적 위축이 낮을수록 높은 상관관계를 보였다. 지역사회 참여 요인 중 삶의 질에 가장 큰 영향을 주는 변인으로는 질병의 정도와 참여주도권이 나타났다. 결론 : 뇌졸중 환자의 삶의 질에 미치는 영향은 질병의 정도와 선거참여 정도, 지역사회 참여 4가지 요인(참여 주도권, 사회적 유대 및 관계, 참여의 의의, 사회적 위축)이 중요한 변인으로 분석되었다. 뇌졸중 환자의 삶의 질을 증진시키기 위한 방안으로 사회 참여요인을 적용하여 의미 있는 작업치료 기초자료로 사용되길 기대한다.

Background: Stroke recovery is a long and complex process. Successful stroke recovery seems to be strongly associated with patients’ high motivation and committed participation. Patients’ motivation is a key determinant of successful rehabilitation outcomes, but it is difficult in defining and measuring. Patients’ participation is defined as the degree or extent to which subjects take part in rehabilitation activities and can be measured by observable behavior. Objects: The purpose of this study was to investigate the impact of patients’ level of participation in rehabilitation on functional outcomes in patients with stroke. Methods: Forty post-stroke inpatients participated in this study. The level of rehabilitation participation was measured by the Hopkins Rehabilitation Engagement Rating Scale (HRERS). Other measures used for the evaluation were the Rivermead Mobility Index (RMI) and Korean version of the Modified Barthel Index (K-MBI). Overall measurements were made at early intervention and late intervention. Spearman correlation and multiple regression were used to measure the relationships between HRERS, RMI, and K-MBI. Results: The correlation found between HRERS total scores at early intervention and RMI total scores of late intervention was above moderate (r = 0.607, p < 0.01). RMI total scores at early intervention (p < 0.000), HRERS total scores at early intervention (p < 0.001), and disease duration (p < 0.003) were significant predictors of RMI total scores at late intervention. Conclusion: The level of participation at early intervention was associated with improvement in mobility. The level of mobility at early intervention, disease duration, and patients’ participation at early intervention were important determinants of functional outcome. These findings suggest that patients’ participation should be encouraged in order to achieve successful stroke recovery.

Background: As technology has progressed, various robot-assisted devices have been developed to reduce therapists’ labor and assist in therapy. However, due to their many limitations, it is more practical to use traditional mechanical devices. The grahamizer is one such traditional mechanical device used clinically to rehabilitate the upper extremities. No study has yet established the efficacy of the grahamizer in individuals with stroke. Objects: This study investigated the immediate change in arm reaching after the use of a grahamizer. Methods: Twenty-two stroke survivors participated in this study (11 males and 11 females). The reaching of the more-affected arm was measured three times using the three-dimentional electromagnetic motion tracking system “trakSTAR”. After the first measurement, the subjects performed 500 rotatory arm exercises using the grahamizer. To assess the grahamizer’s effect, the subjects were remeasured in the same way. Results: There were significant increases in the reaching distance (p < 0.05) and movement smoothness (p < 0.05) of the more-affected arm after using the grahamizer. Conclusion: Our study confirms that using the grahamizer is beneficial in the rehabilitation for improving movement of the more-affected arm in stroke survivors.

Background: Foot drop is a common symptom after stroke and causes walking disorders. Therefore, its proper treatment is important for improving the walking ability of patients with foot drop. Objective: This study aimed to investigate the effects of electrostimulation during walking on the walking ability of patients with foot drop after stroke. Design: Quasi-experial study. Methods: The study enrolled 18 patients with foot drop after stroke. All subjects were assigned to the experimental or control group. The experimental group underwent electric stimulation during walking, while the control group used ankle foot orthoses. Both groups received treatment 20 minutes a day 5 times a week for 4 weeks. Outcome measures were assessed for walking and balance ability using the 10-m walking test (10MWT), 6-min walking test (6MWT), and Timed Up and Go test (TUG) Results: After the intervention, both groups showed significant improvements in 6MWT and TUG results. However, the experimental group showed significantly better improvement on all tests than the control group. Conclusion: The foot drop stimulator effectively improved the walking and balance ability of patients with foot drop after stroke.

Background: Walking is a complex activity. The main components of walking include balance, coordination, and symmetrical posture. The characteristics of walking patterns of stroke patients include slow walking, measured by gait cycle and walking speed. This is an important factor that reflects post-stroke quality of life and walking ability. Objective: This study aimed to examine the effect of deep lumbar muscle stabilization exercise on the spatiotemporal walking ability of stroke patients. Design: Quasi-experial study Methods: The experiment was conducted 5 times per week for 4 weeks, with 30 minutes per session, on 10 subjects in the experimental group who performed the deep lumbar muscle stabilization exercise and 10 subjects in the control group who performed a regular exercise. Variables that represent the spatiotemporal walking ability (step length, stride length, step rate, and walking speed) were measured using GAITRrite before and after the experiment and were analyzed. Results: There was a significant difference in the pre- and post-exercise spatiotemporal walking ability between the two groups (p<.05). Furthermore, there was a significant difference in the step rate and walking speed between the two groups (p<.05). Conclusions: Deep lumbar muscle stabilization exercise is effective in improving the walking ability of stroke patients. Therefore, its application will help improve the spatiotemporal walking ability of stroke patients.