Immediate effects of therapeutic facilitation on the gait of hemiparetic patients as compared with walking with and without a cane

Objectives: Although the neurodevelopmental technique (Bobath) is the most widely used approach in the gait rehabilitation of hemiparetic subjects in Europe, there is little neurophysiological evidence for its presumed effect s on gait symmetry and facilitation of paretic muscles during the therapeut ic intervention. The study, therefore, investigated the immediate effects o f gait entrainment by a physical therapist on the gait of hemiparetic subje cts. Methods: Cycle parameters, gait symmetry, hip joint movement and the electr omyographic activity of several lower limb muscles were assessed in 22 pati ents during a classic intervention by five Bobath therapists and while walk ing-with and without a cane. Results: Multivariate statistics revealed that, while being assisted by the therapist, patients walked faster (P = 0.022), with a longer relative stan ce period of the affected leg (P = 0.005), a higher symmetry (P = 0.002), l arger hip extension (P = 0.001) and more activation (P = 0.026) of the Mm. triceps surae, vastus lateralis, biceps femoris and gluteus medius as compa red to walking with and without a cane. Extensor spasticity of the plantar- flexor tended to increase (n.s.). In five subjects, no after-effect could b e documented 1 h after a gait training of 30 min. Conclusions: The study confirmed a more balanced walking pattern in conjunc tion with facilitation of various weight bearing muscles during the therape utic intervention. A prolonged single stance period of the affected leg, an unobstructed hip movement, enhanced weight acceptance and a faster gait se emed to be responsible for the observed immediate effects of the therapeuti c intervention. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.