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: 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. · 4.25 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
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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. · 0.18 Impact Factor