Lateralization in stroke syndromes as a factor in ambulation

Lateralization should not be ignored in any rehabilitation program for patients with stroke syndromes. Despite the known differences resulting from the localization in the dominant versus the nondominant hemisphere (spatial perception, speech, etc.), practical application of this knowledge in gait training is sparse. The authors looked into different stages of ambulation and the time sequence between these stages and the onset of disease. Standing and walking in parallel bars and outside, as well as elevation activities were given numerical values in an effort to assess abilities quantitatively. The assessment of each patient was recorded graphically (stage of gait against time) and then the different graphs were summated in order to form a common right hemiparetic versus left hemiparetic curve. This study of 236 out of 298 patients (129 left hemiparetics and 107 right ones) showed the following: (1) The right hemiparetics progressed more rapidly in all stages of ambulation, statistically significant figures being obtained for the first two stages; (2) a greater percentage of right versus left hemiparetics reached the assigned levels of ambulation: and (3) 89% out of the 236 patients included in our study were able to ambulate in parallel bars, 81% outside the bars and 38.5% were proficient in stair climbing. Out of the original total number of patients (298), 64% were able able to ambulate outside the bars.