The effect of a slider shoe on hemiplegic gait

Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients

Objective: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients.

Design: Crossover design with randomized order of the intervention.

Setting: A rehabilitation centre for adults with neurological disorders.

Subjects: Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury.

Measures: Postural sway, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone.

Results: AFO significantly improved weight-bearing on the affected leg (affected/ unaffected side symmetry: 2.259 ± 1.5 with AFO versus 3.49 ± 2.5 without AFO, P B ± 0.05) and postural sway in stance (12.5 mm9 ± 5.2 with AFO versus 15.7 mm9 ± 6.7 without AFO, P < ± 0.05), double stance duration (21.19 ± 14.4% of gait cycle with AFO versus 25.99 ± 21.6% of gait cycle without AFO, P < ± 0.05), and symmetry ratios of gait parameters such as stance duration (2.09 ± 1.5 s with AFO versus 3.39 ± 3.6 s without AFO, P < ± 0.05) and deceleration forces (1.69 ± 0.5 with AFO versus 1.99 ± 0.6 without AFO, P < ± 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters.

Conclusion: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.

A content analysis of physiotherapy for postural control in people with stroke: An observational study

PURPOSE

The lack of information about the content of therapy packages is a frequent criticism in stroke rehabilitation research. This study aimed to describe, in detail, the content of one aspect of physiotherapy; the rehabilitation of postural control.

METHODS

The design was a cross-sectional survey and the setting was in 11 NHS Trusts. The participants were 35 stroke physiotherapists working in acute and rehabilitation settings who recorded the treatment of 132 patients in 644 treatment sessions using the Stroke Physiotherapy Intervention Recording Tool. Analysis was carried out by descriptive statistics, one-way ANOVAS and chi-squares which were used to describe content of interventions and effects of the aim of treatment.

RESULTS AND CONCLUSIONS

Physiotherapists' clinical practice focused on therapist-led interventions, which aimed to normalize muscle tone and promote normal movement patterns. The most frequent interventions were 'preparation for treatment' (n = 1969, 43%), 'practising balance and walking activities' (n = 1583, 34%) and 'practising functional tasks' (n = 703, 15%). Interventions to encourage independence or activity outside the treatment session were rarely used. This pattern was seen regardless of the aim of treatment (the restoration of sitting balance, standing balance or stepping/walking).

Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait

BACKGROUND AND PURPOSE

Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis.

SUBJECTS

Eight people who were ambulatory after chronic stroke were evaluated.

METHODS

An A(1)-B-A(2) single-case study design was applied. Phases A(1) and A(2) included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters.

RESULTS

An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A(1) and A(2).

DISCUSSION AND CONCLUSION

The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training--treadmill training with BWS and FES--may decrease the number of people required to carry out the training.