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: 3.25). 04/2001; 81(3):924-35.
Source: PubMed

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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    • "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.
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    ABSTRACT: SUMMARY Objective. To compare the peak of foot pressure between the affected limb with non-affected in hemiparetics patients post stroke and verify the regions of the foot where finding the peaks of pressure in these patients. Method. We evaluated nine patients, with mean age from 56 to 77 years, 5 men and 4 women, 8 patients with ischemic stroke and 1 with hemor- rhagic stroke. We used the baropodometric computerized, by F-Scan system, to evaluate foot pressure. Three regions of the foot were analyzed and divided in forefoot, midfoot, and heel. The analysis of the data was descriptive and using aver- age and absolute frequency. Results. We observed that the sample presenting an average of foot pressure bigger in non- affected side of the body than in the affected side, and that in the both sides, the region of the foot where have more pres- sure is the forefoot. Conclusion. We concluded that there is a decrease of the plantar pressure in hemiparetic side of the patients post stroke with predominance of the peak of pres- sure in forefoot region.
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