Effect of a physical therapy program with task-oriented approach and backward gait training in the locomotion after stroke: cases serie
DOI:
https://doi.org/10.33233/fb.v21i2.2499Keywords:
stroke, locomotion, gait, task orientedAbstract
Introduction: Patients after stroke usually have gait dysfunctions, presenting slow speed, low resistance over long walking distances, and limitation of independent walking outdoors. The recovery of community walking is for those individuals, one of the main goal necessary to keep an active life. Objective: To investigate the effectiveness of a physical therapy intervention with the task-oriented method associated with backward gait training on the locomotion of hemiparetic patients after stroke. Methods: This study is a cases serie, to analyze therapeutic effect, in which the subject is his own control, and multiple evaluations are performed for each subject in phases A1 - B - A2. In phase A1 two pre-treatment assessments are performed, generating a baseline that includes the normal variation of the subject. In phase B two assessments are also made, but during and immediately after treatment to obtain changes related to the treatment effect and, in phase A2, two assessments are made, after two weeks and one month without treatment, phase A2 is to assess retention of treatment. This study was conducted with community-walking strokes survivors (capable of walking on the street, with or without orthoses). The constructs used to assess the effect of therapy on participants were: advanced balance, community gait with ability to change functional tasks, speed and mobility, which were investigated with the Fullerton Advanced Balance (FAB) instruments, Dynamic Gait Index (DGI) and Timed Up Go (TUG). Two statistical methods were used: 1) The visual method of the band formed by the mean and by two standard deviations calculated from the results of the baseline evaluations, forming a band where the points that fall outside the band have a significance of p < 0.05 and 2) The size calculation of the effect of therapy with the Glass Delta method. Results: Four volunteers with stroke sequelae participated in the study. After applying the intervention protocol with task-oriented approach and backward gait training, it was observed an improvement in balance and mobility, as well as locomotion and gait modification ability to functional activities, that was observed especially in the TUG where all participants decreased the time after treatment in approximately 3 to 20 seconds, p < 0.05. Post-therapy effect sizes were large to huge > 0.80 and 1.30 for all participants in two of the three primary outcomes. Conclusion: The association of task-oriented training with backward gait training within the functional rehabilitation process of patients after stroke has positive effects on locomotion.
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