alking is possible for the majority of patients following stroke, but it rarely returns to normal.
Therefore, gait re-education is an important physical ther-apy intervention for patients following stroke. The walk-ing patterns of both individuals without mobility problems
and patients with hemiplegia
have been welldocumented. The gait of people following stroke ischaracterized by problems with generating, timing, andgrading of muscle activity, hypertonicity, and mechani-cal changes in soft tissues.
Gait speed, stride length, andcadence are lower than normal values.
Common kine-matic deviations during the stance phase of the gait cycleare decreased peak hip extension angles, decreasedlateral pelvic displacement, changed knee extension,and decreased plantar-flexion angles.
Common kine-matic deviations during the swing phase of the gait cycleare decreased hip flexion, knee extension, and dorsiflex-ion.
Kinetic characteristics and abnormal motion of theunaffected side have not been commonly documentedin patients following stroke.
The most effective treat-ment strategies to use in gait re-education followingstroke remain unknown.
This case report describes gait re-education based on the Bobath concept, which is oneof the leading treatment approaches in Europe forrehabilitation of patients with stroke.
Bobath considered abnormal coordination of movement patterns and abnormal tone to be the main problems of people with hemiplegia.
is defined as the amount of tension in a muscle (muscle tone) or the overall stateof tension in the body (postural tone).
Therapistsusing Bobath’s concept believe that abnormal tone, which can be lower or higher than normal, influencesthe patient’s movement patterns adversely. Normalizingtone is seen as necessary preparation for practicingfunctional activities suchas walking.
Facilitationof selective control of movement, achieved by the re-education of basicmovement patterns of the trunk, the pelvis,and the limbs, is akey feature of theapproach.
Therapistsbelieve that too mucheffort by the patient andoveruse of the unaf-fected side reinforceabnormal tone andmovement of the affected side.
This is why there is anemphasis on “hands-on” therapy to encourage the use of the affected side and an avoidance of resisted exercise tostrengthen muscle. Therapists use their handling tech-niques to correct alignment, to assist movement that thepatient struggles to perform independently, and to blockatypical movements (ie, movements that differ frompatterns of coordination used in everyday tasks).
Thisreduces the patient’s effort during movement, thusnormalizing tone and producing more selective move-ment as opposed to stereotypical mass patterns.
Resistedexercise also may result in excess effort by the patient.Therapists using Bobath’s concept believe that this overex-ertion will produce overflow and irradiation through thebody, thereby reinforcing abnormal tone and stereotypicalmass patterns of the affected side. Therefore, resistedexercise is usually avoided in patients with abnormal tone,mass movement patterns, and malalignment.The therapist’s handling techniques provide posturalstability and alignment and guide the patient toward
S Lennon, MSc, BSc (Physical Therapy), MCSP, is Lecturer in Physiotherapy, Rehabilitation Sciences Research Group, School of Health Sciences,University of Ulster at Jordanstown, Newtownabbey, County Antrim, Northern Ireland BT 37 OQB (email@example.com).
This article was submitted September 29, 1999, and was accepted August 10, 2000.
In the Bobathconcept, abnormal coordination of movement patterns and abnormal tone are considered the main problems for people withhemiplegia.
Physical Therapy . Volume 81 . Number 3 . March 2001 Lennon . 925