Effects of overloading of the lower hemiparetic extremity on walking speed in chronic stroke patients: A pilot study¹

Article type: Research Article

Authors: Kollen, Boudewijn J.^{a; *} | Rietberg, Marc B.^b | Kwakkel, Gert^b | Emmelot, Cornelis H.^c

Affiliations: [a] Department of Physiotherapy, Isala Clinics, site Sophia, Zwolle, The Netherlands | [b] Department of Physiotherapy and Research Institute for Fundamental and Clinical Human Movement Sciences, University Hospital Vrije Universiteit, Amsterdam, The Netherlands | [c] Department of Rehabilitation Medicine, Isala Clinics, site Sophia, Zwolle, The Netherlands

Correspondence: [*] Afdeling Fysiotherapie, Isala Klinieken locatie Sophia, Postbus 10400, 8000 GK Zwolle, The Netherlands. Tel.: +31 38 4245327; Fax: +31 38 4247676; E-mail: [email protected]

Note: [1] Presented as a poster at the 2nd World Congress in Neurological Rehabilitation, Toronto, Ontario in Canada on April 14, 1999.

Abstract: The objective of this pilot study was to investigate the carry-over effects on comfortable walking speed after overloading the lower hemiparetic extremity in chronic stroke patients. A single subject research study was conducted using a withdrawal design (A-B-A-B-A) on three patients with ischaemic middle cerebral artery infarction. Chronic stroke patients were recruited with stage 3 or 4 Fugl-Meyer scores in the lower extremity and the ability to ambulate independently without walking aids. Based on this withdrawal design, the daily procedure included walking at comfortable speeds 5 × 10 meters during the A1 phase and 3 × 10 meters during all subsequent phases. This procedure was repeated for five consecutive days. Two lbs (B1) and 6 lbs (B2) weight cuffs were attached to the distal lower hemiparetic extremity and randomized over the two B phases. Control (A1, A2, A3) and intervention (B1, B2) phases were alternated with brief resting periods. Mean comfortable walking speed for 10 meters constituted the outcome variable. All patients showed significant differences between phases (χ2=34.187; p<0.001). However, with the exception of a carry-over effect between the A1 (0.86 m/sec) and A2 (0.89 m/sec) phases in one subject (p=0.043) no significant carry-over effects were found on ensuing A2 and A3 control phases. Although gradual improvements in comfortable walking speed between subsequent days were found the present pilot study did not demonstrate favorable group effects on comfortable walking speed as a result of limb overloading.

Keywords: hemiplegia, stroke rehabilitation, overloading, weights, physical therapy

DOI: 10.3233/NRE-2000-14305

Journal: NeuroRehabilitation, vol. 14, no. 3, pp. 159-164, 2000