Gait training in hemiparetic stroke patients

The major goal of neurological rehabilitation includes restoration of mobility. In mobility we include walking, standing up, sitting down, weight shifting from one leg to the other, turning around, initiating and stopping locomotion, as well as climbing stairs. The therapeutic procedures include: different concepts of physiotherapy stressing different features, like force exercise, reduction of spasticity, gait symmetry, utilization of equilibrium reflexes, stepping automation, endurance training, repetition of rhythmic movements etc. The spectrum of available therapies was recently widened by treadmill training with partial body-weight support, gait machines, by functional electrical stimulation (FES), locomotor pharmacotherapy, selective reduction of spasticity by botulinum-toxin (BTX) injections, acoustic and visual cuing and biofeedback. These methods pertaining to gait improvement will also be described. Technical aids should be prescribed earlier, since their costs are usually almost negligible if compared to the costs for a prolonged inpatient treatment. Treadmill training with partial body-weight support in a parachute harness allows early training of postural reactions and stepping. The gait pattern can be considerably improved by FES. A new approach includes mechanical and computer controlled training machines to enable the repetitive training of complex gait cycles without overstressing therapists. First results demonstrate positive effects beyond the classical retraining procedures.