GAIT OUTCOME IN AMBULATORY HEMIPARETIC PATIENTS AFTER A 4-WEEK COMPREHENSIVE REHABILITATION PROGRAM AND PROGNOSTIC FACTORS

Background and Purpose Although gait training is prominent in the reha bilitation of hemiparetic stroke patients, little is known about its o utcome and prognostic factors in mildly affected patients. We therefor e intended to assess gait in ambulatory stroke patients before and aft er a 4-week inpatient rehabilitation program based on the neurodevelop mental technique. Methods We measured vertical ground reaction forces by force plates in 148 stroke patients. Variables were stance duration s, peak vertical ground reaction forces at heel strike (Fz1) and toe-o ff (Fz2), loading and deloading rates, time to Fz1, and time to Fz2. T he absolute changes far both legs and symmetry outcome were calculated . In addition, we assessed maximal walking speed, walking endurance, s tair climbing ability, and the Motricity Index. Results Stance duratio n, weight acceptance, push-off of both legs, and the stance duration s ymmetry improved independent of changes of gait velocity. The symmetry of the ground reaction forces did not improve. Results were even wors e for Fz1 and the loading rate at the end of treatment. Sex, age, side of hemiparesis, motor strength, stroke interval, and sensory impairme nt had no influence on the outcome of symmetry. Functional performance did not improve considerably. Conclusions The absolute changes of the ground reaction forces indicated better weight acceptance and push-of f of both legs and thus confirmed the efficacy of the neurodevelopment al technique. The symmetry outcome and the functional performance at t he end of treatment, however, challenge the efficacy of intensive reha bilitation therapy for 4 weeks in its attempts to restore physiologica l gait in these mildly affected patients.