Gait training efficacy using a home-based practice model in chronic hemiplegia.
OBJECTIVE
The efficacy of a home practice model for gait training was evaluated in 18 hemiplegic subjects 2.3 years (range, 1 to 5) after stroke.


METHODS
Uncontrolled case series.


METHODS
Referral center.


METHODS
Patients at least 1 year poststroke referred to an outpatient rehabilitation program.


METHODS
Patients were taught home programs in two or more 2- to 5-day blocks averaging 35 physical therapy (PT) contact hours (range, 9.5 to 62.5); training extended over a mean of 22 months (range, 10 to 65). Training emphasized weight bearing, balance, segmental control, stretching, and bracing.


METHODS
Gait changes were measured using the newly developed Wisconsin Gait Scale (WGS). The patient-rated Falls Efficacy Scale (FES) was administered before and after training to 8 subjects, and the Health Status Questionnaire (HSQ) was retrospectively administered to all subjects to appraise subjective pretraining to posttraining changes and current psychological status.


RESULTS
The average WGS score significantly improved (p < .05). Patients perceived that gait training increased the quality of their functional activities (p < .05). In a subset of patients, the FES showed that fear of falling was decreased (p < .05). Perception of well-being was comparable to a normative nonstroke reference population except for physical functioning. Compared to the only other published series (using traditional outpatient programming), the current model was of comparable cost.


CONCLUSIONS
Despite the literature indicating a plateau in mobility function by 6 months after stroke, postacute training of gait in hemiplegic subjects using a home-based training model results in improved gait and the perception of improved function. Additionally, we provide validation for the newly developed Wisconsin Gait Scale, an instrument of gait measurement that may assist in comparing outcomes.
Rodriquez
A A
AA
Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School 53792, USA.
Black
P O
PO
Kile
K A
KA
Sherman
J
J
Stellberg
B
B
McCormick
J
J
Roszkowski
J
J
Swiggum
E
E
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005684:Gait; D006305:Health Status Indicators; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D016896:Treatment Outcome