Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke.
ABSTRACT 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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ABSTRACT: To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis. Randomized, single-blind, controlled pilot study. Inpatient rehabilitation hospital. Twenty-five subjects were randomly assigned to either the experimental group or the control group, with 13 and 12 subjects, respectively. All subjects received a routine physical therapy. The subjects in the experimental group also received community-based ambulation training, which was performed for an hour, once a day, three times a week for a four-week period. Ten-metre walk test, 6-minute walk test, community walk test, walking ability questionnaire and activities-specific balance confidence scale before and after the intervention. The change values of the 10-m walk test (0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s), community walk test (-13.61 ± 10.31 minutes versus -3.27 ± 11.99 minutes), walking ability questionnaire (6.15 ± 3.60 score versus 2.75 ± 2.38 score) and activities-specific balance confidence scale (17.45 ± 11.55 score versus 2.55 ± 10.14 score) were significantly higher in the experimental group than in the control group (P < 0.05). At post-test, the 10-m walk test was significantly higher in the experimental group than in the control group (0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s) (P < 0.05). In the experimental group, there were significant differences for all variables between pre-test and post-test (P < 0.01), whereas the subjects of the control group showed a significant difference in only the walking ability questionnaire (P < 0.01). The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy.Clinical Rehabilitation 01/2011; 25(5):451-9. · 2.19 Impact Factor
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ABSTRACT: Abnormalities of gait and changes in posture during walking are more common in older adults than in young adults and may contribute to an increase in the energy expended for walking. The objective of this study was to examine the contributions of abnormalities of gait biomechanics (hip extension, trunk flexion, and foot-floor angle at heel-strike) and gait characteristics (step width, stance time, and cadence) to the energy cost of walking in older adults with impaired mobility. A cross-sectional design was used. Gait speed, step width, stance time, and cadence were derived during walking on an instrumented walkway. Trunk flexion, hip extension, and foot-floor angle at heel contact were assessed during overground walking. The energy cost of walking was determined from oxygen consumption data collected during treadmill walking. All measurements were collected at the participants' usual, self-selected walking speed. Fifty community-dwelling older adults with slow and variable gait participated. Hip extension, trunk flexion, and step width were factors related to the energy cost of walking. Hip extension, step width, and cadence were the only gait measures beyond age and gait speed that provided additional contributions to the variance of the energy cost, with mean R(2) changes of .22, .12, and .07, respectively. Limitations Other factors not investigated in this study (interactions among variables, psychosocial factors, muscle strength [force-generating capacity], range of motion, body composition, and resting metabolic rate) may further explain the greater energy cost of walking in older adults with slow and variable gait. Closer inspection of hip extension, step width, and cadence during physical therapy gait assessments may assist physical therapists in recognizing factors that contribute to the greater energy cost of walking in older adults.Physical Therapy 07/2010; 90(7):977-85. · 2.78 Impact Factor
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ABSTRACT: The aim of the research was to evaluate the results of NDT-Bobath method in gait re-education of adult patients after ischemic stroke using normalized parameters of gait. The investigation group consisted of 60 patients, all sufferers of an ischemic stroke, and participated in a rehabilitation program: 10 sessions of NDT-Bobath therapy through 2 weeks (ten days of the therapy). Normalized parameters of gait were calculated based on anthropometric measures of patients and their gait parameters (gait velocity, cadence and stride length) measured in every patient on admission (before the therapy) and after the last session of the therapy to assess rehabilitation effects. Results among patients involved in the research were as follows: in normalized gait velocity: recovery in 42 cases (70 %), relapse in 10 cases (16,67 %), no measurable changes in 8 cases (13.33 %) in normalized cadence: recovery in 39 cases (65 %), relapse in 16 cases (26.67 %), no measurable changes in 5 cases (8.33 %) in normalized stride length: recovery in 50 cases (83.33 %), relapse in 4 cases (6.67 %), no measurable changes in 6 cases (10 %). Observed statistically significant and favourable changes in health status of patients, described by normalized gait parameters, confirm effectiveness of the NDT-Bobath method.Central European Journal of Medicine 01/2012; · 0.26 Impact Factor