Treatment of the Hemiplegic Patient: New Strategies for Gait Training

Bjorn Svendsen, DHSc, PT

Summary by Patty Davis, MS, Mobility Research, 20 March 1997

When looking at post-stroke disorders, one typically finds gait patterns to be significantly affected. A cerebral vascular occlusion can cause damage which inhibits and/or interferes with the function of specific motor pathways. The decrease in or loss of motor activity/muscle activation causes a corresponding decrease in muscle strength and balance. Muscle contractility and the timing of phasic muscle activation is also adversely affected. Therefore, one of the primary goals of post-stroke rehabilitation should be the restoration of independent ambulation.

Current hemiplegic rehabilitation approaches include the following techniques:

  1. neurodevelopmental (NDT)
  2. Bobath
  3. proprioceptive neuromuscular facilitation (PNF)
  4. Rood
  5. Brunnstroem

The goals of the above mentioned techniques are common in that they attempt to 1) improve muscle contractile forces; 2) increase functional stability; 3) facilitate the relearning of movement patterns; 4) improve the ability to react to forces from many directions; 5) increase muscle activation; 6) improve stance control; and 7) increase load acceptance capabilities. Current theory supports that once the above goals are achieved, the patient can be introduced to activities involving full weight bearing loads such as walking. During gait training, however, abnormalities are still often found in hemiplegic gait patterns. The data suggests that even when adequate muscle activation occurs, the timing of activation is still impaired.

Therefore, new treatment strategies which target muscle activation and the proper sequencing of muscle contraction, weight bearing tolerance, and load acceptance should be employed. Partial weight bearing (PWB) gait therapy protocols allow for the progression of gait therapy from partial weight bearing to full weight bearing, in accordance with each patient's capabilities. The PWB gait therapy approach facilitates muscle activation and contraction sequentially, thus allowing for the retraining of the "load-compensating mechanisms". This type of protocol also allows for balance and posture training to progress as the patient's capabilities increase. PWB gait training seems to be the most progressive rehabilitation technique to date because it addresses hemiplegic gait dysfunction from a more functional, task specific approach.

Svendsen, Bjorn. "Treatment of the Hemiplegic Patient: New Strategies for Gait Training". Physical Therapy Products March:32-34: 1996.

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