Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke

Rehabilitation Sciences Research Group, School of Health Sciences, University of Ulster at Jordanstown, Newtownabbey, County Antrim, Northern Ireland BT 37 OQB, UK.
Physical Therapy (Impact Factor: 2.53). 04/2001; 81(3):924-35.
Source: PubMed


This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy.
One patient ("NM"), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient ("SA"), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept.
At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension.
These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.

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    • "All the subjects received two daily 30-minute sessions of conservative physical therapy for the lower limb region five times a week for four weeks. The conservative physical therapy was based on functional treatment, including sitting to standing, climbing and descending stairs, and using an alternative anteroposterior step11). The experimental group received the sciatic nerve mobilization technique for the lower limb after conservative physical therapy. "
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    ABSTRACT: [Purpose] The purpose of the study was to determine the effects of a sciatic nerve mobilization technique on improvement of lower limb function in patient with poststroke hemiparesis. [Subjects] Twenty- two stroke patients participated in this study. [Methods] They were randomly selected based on selection criteria and divided into two groups. In the subject group (n=10), sciatic nerve mobilization with conventional physical therapy was applied to patients. In the control group (n=10), only conventional physical therapy was applied to stroke patients. [Results] There were significant differences between the two groups in pressure, sway, total pressure, angle of the knee joint, and functional reaching test results in the intervention at two weeks and at four weeks. [Conclusion] The present study showed that sciatic nerve mobilization with conventional physical therapy was more effective for lower limb function than conventional physical therapy alone in patient with poststroke hemiparesis.
    Journal of Physical Therapy Science 07/2014; 26(7):981-3. DOI:10.1589/jpts.26.981 · 0.39 Impact Factor
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    • "It has been used to evaluate BWSTT (McCain et al., 2008; Mulroy et al., 2010; Sousa et al., 2009), therapist facilitation (Lennon, 2001), and use of an assistive device (Kuan et al., 1999) following stroke. Although these studies have investigated the impact of each intervention on gait performance, we are unaware of any study which has systematically examined each of these gait training conditions. "
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    ABSTRACT: Gait training is a major focus of rehabilitation for many people with neurological disorders, yet systematic reviews have failed to identify the most effective form of gait training. The main objective of this study was to compare conditions for gait training for people with acquired brain injury (ABI). Seventeen people who had sustained an ABI and were unable to walk without assistance were recruited as a sample. Each participant was exposed to seven alternative gait training conditions in a randomized order. These were: (1) therapist manual facilitation; (2) the use of a gait-assistive device; (3) unsupported treadmill walking; and (4) four variations of body weight support treadmill training (BWSTT). Quantitative gait analysis was performed and Gait Profile Scores (GPS) were generated for each participant to determine which condition most closely resembled normal walking. BWSTT without additional therapist or self-support of the upper limbs was associated with more severe gait abnormality [Wilks' lambda = 0.20, F(6, 6) = 3.99, p = 0.047]. With the exception of therapist facilitation, the gait training conditions that achieved the closest approximation of normal walking required self-support of the upper limbs. When participants held on to a stable handrail, self-selected gait speeds were up to three times higher than the speeds obtained for over-ground walking [Wilks' lambda = 0.17, F(6, 7) = 5.85, p < 0.05]. The provision of stable upper-limb support was associated with high self-selected gait speeds that were not sustained when walking over ground. BWSTT protocols may need to prioritize reduction in self-support of the upper limbs, instead of increasing treadmill speed and reducing body weight support, in order to improve training outcomes.
    Journal of neurotrauma 02/2011; 28(2):281-7. DOI:10.1089/neu.2010.1649 · 3.71 Impact Factor

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