C Dohle1,2, R Tholen3, H Wittenberg4, J Quintern5, S Saal6, K M Stephan4,7. 1. MEDIAN Klinik Berlin-Kladow, Kladower Damm 223, 14089, Berlin, Deutschland. christian.dohle@median-kliniken.de. 2. Centrum für Schlaganfallforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. christian.dohle@median-kliniken.de. 3. Physio Deutschland - Deutscher Verband für Physiotherapie (ZVK), Köln, Deutschland. 4. St. Mauritius Therapieklinik, Meerbusch, Deutschland. 5. Medical Park Loipl, Bischofswiesen, Deutschland. 6. Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland. 7. SRH Gesundheitszentrum Bad Wimpfen, Bad Wimpfen, Deutschland.
Abstract
BACKGROUND: Approximately two thirds of stroke patients initially suffer from at least impaired mobility. Various rehabilitation concepts have been proposed. OBJECTIVE: Based on the current literature, which rehabilitation methods can be recommended for improvement of gait, gait velocity, gait distance and balance? METHODS: A systematic literature search was carried out for randomized clinical studies and reviews with clinically relevant outcome variables. Formulation of recommendations, separated for target variables and time after stroke. RESULTS: Restoration and improvement of gait function relies on a high number of repetitions of gait movements, which for more severely affected patients is preferentially machine-based. For improvement of gait velocity for less severely affected patients intensive gait training does not necessarily rely on mechanical support. Gait distance can be improved by aerobic endurance exercises with a cardiovascular effect, which have to be performed in a functional context. Improvement of balance should be achieved by intensive functional gait training. Additional stimulation techniques are only effective when included in a functionally relevant training program. DISCUSSION: These guidelines not only provide recommendations for action but also provide pathophysiological insights into functional restoration of stance and gait after stroke.
BACKGROUND: Approximately two thirds of strokepatients initially suffer from at least impaired mobility. Various rehabilitation concepts have been proposed. OBJECTIVE: Based on the current literature, which rehabilitation methods can be recommended for improvement of gait, gait velocity, gait distance and balance? METHODS: A systematic literature search was carried out for randomized clinical studies and reviews with clinically relevant outcome variables. Formulation of recommendations, separated for target variables and time after stroke. RESULTS: Restoration and improvement of gait function relies on a high number of repetitions of gait movements, which for more severely affected patients is preferentially machine-based. For improvement of gait velocity for less severely affected patients intensive gait training does not necessarily rely on mechanical support. Gait distance can be improved by aerobic endurance exercises with a cardiovascular effect, which have to be performed in a functional context. Improvement of balance should be achieved by intensive functional gait training. Additional stimulation techniques are only effective when included in a functionally relevant training program. DISCUSSION: These guidelines not only provide recommendations for action but also provide pathophysiological insights into functional restoration of stance and gait after stroke.
Authors: Anke I Kottink; Hermie J Hermens; Anand V Nene; Martin J Tenniglo; Hans E van der Aa; Hendrik P Buschman; Maarten J Ijzerman Journal: Arch Phys Med Rehabil Date: 2007-08 Impact factor: 3.966
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson; Steven Cen; Sarah K Hayden Journal: N Engl J Med Date: 2011-05-26 Impact factor: 91.245
Authors: D Dias; J Laíns; A Pereira; R Nunes; J Caldas; C Amaral; S Pires; A Costa; P Alves; M Moreira; N Garrido; L Loureiro Journal: Eura Medicophys Date: 2007-12