Walking After Stroke: Interventions to restore normal gait pattern

Stroke is the leading cause of adult disability and inpatient rehabilitation admissions. In spite of many efforts, approximately 35% of stroke survivors with initial paralysis of the leg do not regain useful walking function. Many (potential) impairments and limitations have caused a marked variation in gait patterns among stroke patients. Hemiparetic gait is characterized by slow and asymmetric steps with poor selective motor control, delayed and disrupted equilibrium reactions and reduced weight bearing on the paretic limb. Although some general characteristics of hemiparetic gait have been identified, individual differences are great, emphasizing the need for individual assessment to identify the problems and design therapeutic interventions to address them. To provide a rationale for the proper selection of therapeutic interventions, we assessed the effectiveness of balance training, electrical stimulation, arm sling and AFO to improve hemiparetic gait pattern after stroke. Treatment outcome was evaluated by relevant clinical assessments together with time-distance, kinematic and kinetic gait characteristics measured by a quantitative three-dimensional gait analysis system. We concluded that task-specific interventions together with external feedback (balance training with force platform feedback) and orthosis, either enabling feedback or substituting a lost function or both (arm sling and AFO) are effective in improvement of postural control and gait symmetry in hemiparetic patients with stroke. However, impairment-focused therapies without any volitional participation of the patients (neuromuscular or somatosensory electrical stimulation) are not superior to a conventional stroke rehabilitation program.

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