Hemiplegia

PROCEEDINGS

In persons with poststroke hemiplegia walking ability is compromised. In particular, gait velocity and walking distance is reduced as a result of shorter stride length and slower cadence. This proceeding summarizes efforts to apply and evaluate the performance of subjects who are poststroke using the task of stepping over obstacles to shape an increased stride length. We used virtual objects that were presented while a person was walking on a treadmill and compared it to the use of real obstacles in an overground-walking environment. The virtual object method is potentially more beneficial because it allows individuals to practice stepping over objects of any height and length combination, in a safe and therapeutic environment.

Twenty subjects with chronic poststroke hemiplegia (mean age = 60.7 +/- 2.3 yrs; > 6 months post-onset; 10 right-- sided/10 left-sided paresis) were exposed to 6 intervention sessions where they were engaged with either virtual objects while walking on a motorized treadmill (VR) (N=10) or they were exposed to an overground set of foam objects (OCT) (N= 10) and asked to step over them without collision. Gait velocity was measured using a videotape recording system while the subject walked over a 10-meter walkway (fast walk and self-selected speed walk), and distance during a 6-minute walk test was also measured prior to intervention, after intervention, and after 2 weeks as a follow-up to intervention.

All 20 subjects tolerated the intervention sessions well and there were no incidences of falling or of undue cardiovascular responses. On average, the VR intervention generated greater changes in gait velocity improvement compared with OG during the fast walk test (20.0 +/- 7.3 (SE) vs.11.9 +/- 3.3 (SE) pct. improvement) (p 0.05). Overall, the subjects showed clinically meaningful changes in gait velocity (10.7 m/min self-selected speed and 7.8 m/min fast speed, p

The addition of enhanced safety and visual augmentation may be responsible for the effectiveness of the virtual object intervention. These results demonstrate preliminary evidence for clinical effectiveness of obstacle training for improving gait velocity and walking distance poststroke. In addition, these results give impetus to the further development and implementation of virtual object training in clinical settings.

This work was supported by the Department of Veterans Affairs, Division of Rehabilitation Research and Development.

David A. Brown, PhD, PT1

David L.Jaffe, MS2

Ellie L. Buckley, MS, PT2

1 Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois (d-brownl@northwestern.edu)

2 Palo Alto VA Health Care System, Rehabilitation Research and Development Center, Palo Alto, California

Copyright Neurology Report Jun 2002
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