Gait training efficacy using a home-based practice model in chronic hemiplegia

Area of Science:

• Neurology
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Stroke frequently results in hemiplegia, impacting gait and functional mobility.
• Traditional rehabilitation models often have limitations in long-term efficacy for gait recovery.
• A plateau in mobility is often observed 6 months post-stroke, limiting further gains.

Purpose of the Study:

• To evaluate the efficacy of a home practice model for gait training in hemiplegic subjects.
• To assess improvements in gait quality and functional activities post-stroke.
• To validate the Wisconsin Gait Scale (WGS) as a measure of gait improvement.

Main Methods:

• An uncontrolled case series design was employed with 18 hemiplegic subjects (1-5 years post-stroke).
• Subjects received intensive home-based gait training over a mean of 22 months, focusing on weight bearing, balance, and segmental control.
• Gait was assessed using the Wisconsin Gait Scale (WGS), with patient-reported outcomes including the Falls Efficacy Scale (FES) and Health Status Questionnaire (HSQ).

Main Results:

• Significant improvements in average Wisconsin Gait Scale (WGS) scores were observed (p < .05).
• Patients reported enhanced quality of functional activities and decreased fear of falling (p < .05).
• The home-based model demonstrated comparable costs to traditional outpatient programming.

Conclusions:

• Postacute, home-based gait training can significantly improve gait and perceived function in hemiplegic stroke survivors, challenging the notion of a mobility plateau.
• The study validates the Wisconsin Gait Scale (WGS) as a reliable instrument for measuring gait outcomes.
• This home-based model offers a viable and effective alternative for long-term gait rehabilitation after stroke.