Authors (including presenting author) :
Fong IC, Hui WH, Tam WT, Cheung KW, Tsang YL, Man WK, Fung YH
Affiliation :
Department of Physiotherapy, Caritas Medical Centre
Introduction :
Stroke incidence in young individuals is growing. One of the most striking disabilities among these patients is impaired gait, which can result in significant limitation in activity. Therefore, restoration of walking is the primary goal of rehabilitation. This training program aims at using instrumented gait analysis to analyze gait impairment and thereby designing specific treatment plans to cater individual needs. The effectiveness of the program is reflected by the change in the gait parameters, dynamic balance, gait symmetry and patient’s subjective balance confidence in daily activities.
Objectives :
1. To provide tailor-made advanced training to young stroke patients to improve gait stability 2. To improve balance, as well as balance confidence in daily activities 3. To evaluate the change in gait stability by using instrumented gait analysis
Methodology :
Subacute stoke patients who are younger than 65 years old were recruited from the Geriatric Day Hospital (GDH) in CMC.The training frequency was 2 times per week and the training period was 10 weeks. Pre and post physiotherapy stroke assesssments and instrumented gait analysis were conducted to evaluate the change of the outcomes of the patients. Interventions including task-specific exercise training (ie. advanced balance training, coordination exercise, gait re-education and home exercise) were delivered to the patients based on the results of the assessment.
Result & Outcome :
Four groups of outcomes were evaluated: 1.Gait parameters: Walking speed, cadence and paretic step length 2.Dynamic balance: Percentage of double support, Berg balance scale(BBS) and timed-up-and-go(TUG) test 3.Gait symmetry : Lateral shift of centre of pressure (COP) of gait and its standard deviation 4.Subjective balance confidence: Activities-specific balance confidence scale (ABC) questionnaire 16 patients were recruited in this program. The mean age was 54.5 years old. 1)Gait parameters : The overground walking speed increased from 0.59m/s to 0.93m/s (p< 0.01). The step length of paretic side increased by 46% (p< 0.01). The cadence increased from 85 steps/min to 100 steps/min (p< 0.01). 2) Dynamic balance: The dynamic walking stability improved as they became less dependent on double leg support during walking (decreased from 42.9% to 35.3% of the gait cycle). Also, the BBS score increased from 38 to 50 (p< 0.01), while the duration of TUG test improved by 37% (p< 0.01). 3) Gait symmetry : The gait became more symmetrical as the lateral shift of COP of gait decreased from 13.4mm to 6.4mm (p< 0.01), while its standard deviation decreased from 24.8mm to 11.0mm (p< 0.01). 4) Subjective balance confidence: The ABC score increased from 69.8 to 82.6 (p< 0.01). In conclusion, the gait parameters, walking stability, balance and subjective balance confidence of the patients improved.
