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Current Treatment Options in Neurology
Published in: Current Treatment Options in Neurology 6/2012

01-12-2012 | CEREBROVASCULAR DISORDERS (HP ADAMS JR, SECTION EDITOR)

Rehabilitation of Walking After Stroke

Authors: Mark G. Bowden, PhD, PT, Aaron E. Embry, PT, DPT, MSCR, Lindsay A. Perry, PT, DPT, NCS, Pamela W. Duncan, PhD, PT, FAPTA

Published in: Current Treatment Options in Neurology | Issue 6/2012

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Opinion statement

Rehabilitation of walking after stroke has been investigated with a variety of interventions, which will be outlined in this review. To date, the majority of interventions have demonstrated a positive, but similar effect in the primary clinical outcome of self-selected walking speed. Consistent among the most successful interventions is a focus on the intensity of the intervention and the ability to progress rehabilitation in a structured fashion. Successful progression of rehabilitation of walking likely lies in the ability to combine interventions based on an understanding of contributing underlying deficits (eg, motor control, strength, cardiovascular endurance, and dynamic balance). Rehabilitation programs must account for the need to train dynamic balance for falls prevention. Lastly, clinicians and researchers need to measure the effects of rehabilitation on participation and health related quality of life.
Literature
1.
Dickstein R. Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair. 2008;22:649–60.PubMedCrossRef
2.
Bowden MG, Embry AE, Gregory CM. Physical therapy adjuvants to promote optimization of walking recovery after stroke. Stroke Res Treat. 2011;2011:601416.PubMed
3.•
Duncan PW, Sullivan KJ, Behrman AL, et al. Body-weight-supported treadmill rehabilitation after stroke. N Eng J Med. 2011;364:2026–36.CrossRef
4.
Lang CE, Macdonald JR, Reisman DS, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90:1692–8.PubMedCrossRef
5.
Duncan P, Studenski S, Richards L, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003;34:2173–80.PubMedCrossRef
6.
Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234–43.PubMedCrossRef
7.
Stoller O, de Bruin ED, Knols RH, Hunt KJ. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol. 2012;12:45.PubMedCrossRef
8.
Globas C, Becker C, Cerny J, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair. 2012;26:85–95.PubMedCrossRef
9.
Pohl M, Mehrholz J, Ritschel C, Ruckriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33:553–8.PubMedCrossRef
10.
Tyrell CM, Roos MA, Rudolph KS, Reisman DS. Influence of systematic increases in treadmill walking speed on gait kinematics after stroke. Phys Ther. 2011;91:392–403.PubMedCrossRef
11.
Lau KW, Mak MK. Speed-dependent treadmill training is effective to improve gait and balance performance in patients with sub-acute stroke. J Rehabil Med. 2011;43:709–13.PubMedCrossRef
12.
Reisman DS, McLean H, Bastian AJ. Split-belt treadmill training poststroke: a case study. JNPT. 2010;34:202–7.PubMed
13.
Hesse S. Treadmill training with partial body weight support after stroke: a review. Neuro Rehabil. 2008;23:55–65.
14.
Moseley AM, Stark A, Cameron ID, Pollock A. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2005;CD002840.
15.
Dobkin BH, Duncan PW. Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate? Neurorehabil Neural Repair. 2012;26:308–17.PubMedCrossRef
16.
Waldner A, Tomelleri C, Hesse S. Transfer of scientific concepts to clinical practice: recent robot-assisted training studies. Funct Neurol. 2009;24:173–7.PubMed
17.
Schuck A, Labruyere R, Vallery H, Riener R, Duschau-Wicke A. Feasibility and effects of patient-cooperative robot-aided gait training applied in a 4-week pilot trial. J Neuroeng Rehabil. 2012;9:31.PubMed
18.•
Schwartz I, Sajin A, Fisher I, et al. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. PMR. 2009;1:516–23.
19.
Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, et al. Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil. 2011;8:66.PubMedCrossRef
20.
Khanna I, Roy A, Rodgers MM, Krebs HI, Macko RM, Forrester LW. Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke. J Neuroeng Rehabil. 2010;7:23.PubMedCrossRef
21.
English C, Hillier S. Circuit class therapy for improving mobility after stroke: a systematic review. J Rehabil Med. 2011;43:565–71.PubMedCrossRef
22.
Brazzelli M, Saunders DH, Greig CA, Mead GE. Physical fitness training for patients with stroke: updated review. Stroke. 2012;43:e39–40.PubMedCrossRef
23.
Hammami N, Coroian FO, Julia M, et al. Isokinetic muscle strengthening after acquired cerebral damage: a literature review. Ann Phys Rehabil Med. 2012;55:279–91.PubMed
24.•
Flansbjer UB, Lexell J, Brogardh C. Long-term benefits of progressive resistance training in chronic stroke: a 4-year follow-up. J Rehabil Med. 2012;44:218–21.PubMedCrossRef
25.
Fritz S, Merlo-Rains A, Rivers E, et al. Feasibility of intensive mobility training to improve gait, balance, and mobility in persons with chronic neurological conditions: a case series. J Neurol Phys Ther. 2011;35:141–7.PubMed
26.•
Andersen LL, Zeeman P, Jorgensen JR, et al. Effects of intensive physical rehabilitation on neuromuscular adaptations in adults with poststroke hemiparesis. J Strength Cond Res. 2011;25:2808–17.PubMedCrossRef
27.
Sousa CO, Barela JA, Prado-Medeiros CL, Salvini TF, Barela AM. Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study. J Neuroeng Rehabil. 2011;8:48.PubMedCrossRef
28.
DePaul VG, Wishart LR, Richardson J, Lee TD, Thabane L. Varied overground walking-task practice vs. body-weight-supported treadmill training in ambulatory adults within 1 year of stroke: a randomized controlled trial protocol. BMC Neurol. 2011;11:129.PubMedCrossRef
29.
Dean CM, Rissel C, Sherrington C, et al. Exercise to enhance mobility and prevent falls after stroke: The Community Stroke Club Randomized Trial. Neurorehabil Neural Repair. 2012. doi:10.​1177/​1545968312441711​.
30.
Blennerhassett JM, Dite W, Ramage ER, Richmond ME. Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study. Arch Phys Med Rehabil. 2012. doi:10.​1016/​j.​apmr.​2012.​04.​005.
31.
Taylor D, Hale L, Schluter P, et al. Effectiveness of Tai Chi as a community-based falls prevention intervention: a randomized controlled trial. J Am Geriatr Soc. 2012;60:841–8.PubMedCrossRef
32.
Yang S, Hwang WH, Tsai YC, Liu FK, Hsieh LF, Chern JS. Improving balance skills in patients who had stroke through virtual reality treadmill training. Am J Phys Med Rehabil. 2011;90:969–78.PubMedCrossRef
33.
Laver K, George S, Thomas S, Deutsch JE, Crotty M. Cochrane review: virtual reality for stroke rehabilitation. Eur J Phys Rehabil Med. 2012. [Epub ahead of print].
34.
Deutsch JE. Using virtual reality to improve walking post-stroke: translation to individuals with diabetes. J Diabetes Sci Technol. 2011;5:309–14.PubMed
35.
Seo NJ, Fischer HW, Bogey RA, Rymer WZ, Kamper DG. Use of visual force feedback to improve digit force direction during pinch grip in persons with stroke: a pilot study. Arch Phys Med Rehabil. 2011;92:24–30.PubMedCrossRef
36.
Lewek MD, Feasel J, Wentz E, Brooks Jr FP, Whitton MC. Use of visual and proprioceptive feedback to improve gait speed and spatiotemporal symmetry following chronic stroke: a case series. Phys Ther. 2012;92:748–56.PubMedCrossRef
37.
Ferrante S, Ambrosini E, Ravelli P, et al. A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients. J Neuroeng Rehabil. 2011;8:47.PubMedCrossRef
38.
Deutsch JE, Maidan I, Dickstein R. Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke. Phys Ther. 2012. doi:10.​2522/​ptj.​20110277.
39.
Braun SM, Wade DT, Beurskens AJ. Use of movement imagery in neurorehabilitation: researching effects of a complex intervention. Int J Rehabil Res. 2011;34:203–8.PubMedCrossRef
40.
Maulucci RA, Eckhouse RH. A real-time auditory feedback system for retraining gait. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Boston, MA, 2011. p. 5199–202.
41.
Hollands KL, Pelton TA, Tyson SF, Hollands MA, van Vliet PM. Interventions for coordination of walking following stroke: systematic review. Gait Posture. 2012;35:349–59.PubMedCrossRef
42.
Fung J, Perez CF. Sensorimotor enhancement with a mixed reality system for balance and mobility rehabilitation. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2011. p. 6753–7.
43.
Turns LJ, Neptune RR, Kautz SA. Relationships between muscle activity and anteroposterior ground reaction forces in hemiparetic walking. Arch Phys Med Rehabil. 2007;88:1127–35.PubMedCrossRef
44.
Kesar TM, Perumal R, Reisman DS, et al. Functional electrical stimulation of ankle plantarflexor and dorsiflexor muscles: effects on poststroke gait. Stroke. 2009;40:3821–7.PubMedCrossRef
45.
Embrey DG, Holtz SL, Alon G, Brandsma BA, McCoy SW. Functional electrical stimulation to dorsiflexors and plantar flexors during gait to improve walking in adults with chronic hemiplegia. Arch Phys Med Rehabil. 2010;91:687–96.PubMedCrossRef
46.
Pomeroy VM, King L, Pollock A, Baily-Hallam A, Langhorne P. Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev. 2006;CD003241.
47.
Schuhfried O, Crevenna R, Fialka-Moser V, Paternostro-Sluga T. Non-invasive neuromuscular electrical stimulation in patients with central nervous system lesions: an educational review. J Rehabil Med. 2012;44:99–105.PubMedCrossRef
48.
Mesci N, Ozdemir F, Kabayel DD, Tokuc B. The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: a single-blind, randomized, controlled trial. Disabil Rehabil. 2009;31:2047–54.PubMedCrossRef
49.
Corti M, Patten C, Triggs W. Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review. Am J Phys Med Rehabil. 2012;91:254–70.PubMedCrossRef
50.•
Wang RY, Tseng HY, Liao KK, Wang CJ, Lai KL, Yang YR. rTMS combined with task-oriented training to improve symmetry of interhemispheric corticomotor excitability and gait performance after stroke: a randomized trial. Neurorehabil Neural Repair. 2012;26:222–30.PubMedCrossRef
Metadata
Title
Rehabilitation of Walking After Stroke
Authors
Mark G. Bowden, PhD, PT
Aaron E. Embry, PT, DPT, MSCR
Lindsay A. Perry, PT, DPT, NCS
Pamela W. Duncan, PhD, PT, FAPTA
Publication date
01-12-2012
Publisher
Current Science Inc.
Published in
Current Treatment Options in Neurology / Issue 6/2012
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-012-0198-1

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