Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents

Abstract

The aims of this case report are to describe the application of an early and intensive task-oriented physical therapy program for gait relearning following stroke and to report the patients' ability to comply with the program. Ten patients, 60 to 75 years of age (mean = 69.8, SD = 7.3), with a middle cerebral artery infarct (confirmed by computerized tomography) were assigned to this special physical therapy program. Patients were treated twice a day, 5 days a week, from the eighth day after stroke for 5 consecutive weeks. To promote gait relearning, a program of early standing (using a tilt table when necessary), combined with weight-shifting exercises and feedback via a limb-load monitor as well as locomotor activities including exercises on a Kinetron and treadmill walking, was adapted for each patient's level of motor recovery. Walking on the treadmill (with a safety harness) was initiated as early as the second week after stroke in 4 patients, and all patients had started Kinetron training by the second week. Except for 1 patient, who was withdrawn from the study because of an infection, all patients showed good treatment compliance (93.6%) with the planned 50 treatments and were able to withstand a mean treatment duration of 44.8 minutes (SD = 6.3, range = 37.5-58.5), twice a day, during the first week of the program (8th to 14th day after stroke). Results from this pilot project indicate that intensive and graded locomotor activities can be very well tolerated in the early period after stroke.