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Research Reports |
G Kwakkel, PhD, is Physiotherapist and Human Movement Scientist, Department of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, the Netherlands (g.kwakkel{at}azvu.nl). Address all correspondence to Dr Kwakkel
RC Wagenaar, PhD, is Chairman, Department of Physical Therapy, and Director, Center for Neurorehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass
Background and Purpose. The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Subjects and Methods. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 1
-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Results. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. Discussion and Conclusion. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.
Key Words: Cerebrovascular disorders • Dynamic Pattern Theory • Gait • Hemiplegia • Physical therapy • Walking speed
This article has been cited by other articles:
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  M. Roerdink, C. J. Lamoth, G. Kwakkel, P. C. van Wieringen, and P. J Beek Gait Coordination After Stroke: Benefits of Acoustically Paced Treadmill Walking Physical Therapy, August 1, 2007; 87(8): 1009 - 1022. [Abstract] [Full Text] [PDF]
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 G. Alon, A. F. Levitt, and P. A. McCarthy Functional Electrical Stimulation Enhancement of Upper Extremity Functional Recovery During Stroke Rehabilitation: A Pilot Study Neurorehabil Neural Repair, May 1, 2007; 21(3): 207 - 215. [Abstract] [PDF]
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K. R Archer, R. C Castillo, E. J MacKenzie, M. J Bosse, and and the Lower Extremity Assessment Project (LEAP) Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma Physical Therapy, December 1, 2006; 86(12): 1630 - 1640. [Abstract] [Full Text] [PDF]
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B. Kollen, G. Kwakkel, and E. Lindeman Time Dependency of Walking Classification in Stroke Physical Therapy, May 1, 2006; 86(5): 618 - 625. [Abstract] [Full Text] [PDF]
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 C.M. Cirstea, A. Ptito, and M.F. Levin Feedback and Cognition in Arm Motor Skill Reacquisition After Stroke Stroke, May 1, 2006; 37(5): 1237 - 1242. [Abstract] [Full Text] [PDF]
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J. J. Daly, K. Roenigk, J. Holcomb, PhD, J. M. Rogers, K. Butler, J. Gansen, J. McCabe, E. Fredrickson, E. B. Marsolais, and R. L. Ruff A Randomized Controlled Trial of Functional Neuromuscular Stimulation in Chronic Stroke Subjects Stroke, January 1, 2006; 37(1): 172 - 178. [Abstract] [Full Text] [PDF]
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B. Kollen, I. van de Port, E. Lindeman, J. Twisk, and G. Kwakkel Predicting Improvement in Gait After Stroke: A Longitudinal Prospective Study Stroke, December 1, 2005; 36(12): 2676 - 2680. [Abstract] [Full Text] [PDF]
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G. Kwakkel, R. van Peppen, R. C. Wagenaar, S. Wood Dauphinee, C. Richards, A. Ashburn, K. Miller, N. Lincoln, C. Partridge, I. Wellwood, et al. Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis Stroke, November 1, 2004; 35(11): 2529 - 2539. [Abstract] [Full Text] [PDF]
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 R P. Van Peppen, G Kwakkel, S Wood-Dauphinee, H J. Hendriks, P. J Van der Wees, and J Dekker The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clinical Rehabilitation, August 1, 2004; 18(8): 833 - 862. [Abstract] [PDF]
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N M Salbach, N E Mayo, S Wood-Dauphinee, J A Hanley, C L Richards, and R Cote A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Clinical Rehabilitation, May 1, 2004; 18(5): 509 - 519. [Abstract] [PDF]
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