http://dspace.unm.edu/handle/1928/27704
Author(s)
Subject(s)
hemiparesis
gait training
overground training
body weight supported treadmill training
stroke
gait training
overground training
body weight supported treadmill training
stroke
Abstract
Abstract
Background: Cerebral Vascular Accident (CVA) or stroke, is among the
most common diagnoses seen in an inpatient rehabilitation facility as
more than 790,000 Americans suffer new or recurrent strokes each year.
Of these, approximately two thirds of survivors experience significant
limitations in walking leading to increased risk for falls and
fractures, decreased mobility, limited community access, depression and
decreased quality of life. For this reason, gait training becomes a
major focus of a rehabilitation program. Several common gait training
methods may be implemented which have proven to be effective for
improving gait speed and walking endurance in patients with hemiparesis
(weakness on one side of the body). These may include overground
training, treadmill training with or without body weight support,
robotic-assisted locomotor training and functional electrical
stimulation. Of these methods, overground gait training and treadmill
training are among the most commonly used.
Purpose: The purpose of this literature review is to examine overground
training and body weight supported treadmill training and evaluate which
method of gait training is more effective in improving functional
outcomes in individuals following stroke.
Case Description: This patient is a 35 year old male who suffered a
right hemorrhagic cerebral vascular accident and seizures for which he
underwent a right craniotomy. Patient presents with left hemiparesis,
flaccid left upper and lower extremities, right lateral gaze and
dysphagia. Upon initial evaluation, the patient required maximal two
person assistance for bed positioning and mobility and maximal two
person assistance for all transfers. Patient was only able to walk
approximately 25 feet using an Arjo® Walker (hydraulic lift) at maximal
assist with a dorsiflexion Ace wrap applied to the left lower extremity
and assistance with foot clearance and limb advancement during
ambulation.
Outcomes: Over an eight week period the patient made significant gains.
Patient required moderate assistance with all bed mobility skills and
basic transfers. Both gait training methods were utilized in the
rehabilitation program with an improvement demonstrated in ambulation
with the patient able to ambulate 150 feet using a narrow based quad
cane with moderate assistance and a dorsiflexion wrap to the left lower
extremity. Neither method of gait training was proven to be superior to
the other in improving walking speed and endurance.
Discussion: Evidence shows that both overground gait training and body
weight supported gait training are effective methods for increasing
walking capacity, speed and endurance. No conclusive evidence exists
that suggests that either method is more effective in promoting
functional outcomes. Therefore, selection of intervention must be
determined by the physical therapist based on functional status and
limitations, along with the patient's values, goals, and expectations.
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