Use of three gait-training strategies in an individual with multiple, chronic strokes

There is little information available regarding gait-training interventions for people with chronic, multiple strokes who are nonambulatory. The purpose of this case report is to describe the feasibility and outcome of three different task-oriented gait-training techniques in an individual with chronic, multiple strokes who was not able to ambulate independently.

The participant was a 61-year-old man with chronic quadriparesis resulting from five brainstem strokes sustained over five years previously. He maintained home and community mobility with a power wheelchair but sought to ambulate home and short community distances without assistance. Three six-week gait-training interventions were implemented sequentially twice per week: (1) overground gait training with manual assistance, (2) body weight-supported treadmill training (BWSTT), and (3) overground gait training with variable task practice.

Independent home and short community ambulation was not achieved by this individual after these interventions. However, he improved gait speed and endurance as well as balance over the 18-week intervention period.

There appeared to be no advantage to BWSTT over traditional gait training for this individual, as improvement was noted during all three interventions at a comparable rate. Although these gait-training interventions facilitated gains in gait and balance measures during the treatment, no change in functional ambulation status was achieved. Given the time, financial, and labor demands involved with BWSTT and the lack of apparent benefit, traditional overground therapeutic intervention was reasonable and appropriate for this participant with a history of chronic, multiple strokes.