Background and purpose: This case study and evidence-based analysis aims to determine which intervention or combination of interventions commonly cited in available research is most effective in facilitating a more efficient, coordinated gait pattern in patients with acute stroke. A stroke occurs when a blood vessel in the brain is blocked or bursts, causing damage to the brain. Stroke is the second leading global cause of death and accounts for 11% of deaths worldwide. Stroke continues to be a major cause of disability and a very common diagnosis seen in physical therapy. It is currently controversial which physical therapy interventions are most effective in the treatment of acute stroke and some therapists continue to use interventions that studies have found to be ineffective. Many studies investigating acute stroke have themselves been found to be underpowered, biased and misleading. Case Description: The patient, Mrs. M, was an 85 year old female who suffered a left cerebrovascular accident (CVA) in late November. She was hospitalized 4 days, admitted to a rehabilitation hospital in early December and to a skilled nursing facility in late December. The patient presented with right hemiparesis, decreased muscle strength, right foot drop, an inefficient, uncoordinated gait pattern, impaired balance and transfer abilities, limited overall mobility and safety, expressive and receptive aphasia, fatigue and confusion. In addition to right hemiparesis, she reported significant left flank pain limiting function of her left side. Outcomes: A review of current literature revealed that a intensive and organized treatment plan including some or all of the following specific interventions, tailored to each patients needs with close monitoring of patient response, can decrease deficits, increase independence and improve overall outcomes for patients with acute stroke. The specific recommended interventions include: therapeutic exercise, task-oriented training, biofeedback, overground/treadmill gait training, balance/transfer training, constraint-induced movement therapy (CIMT), treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound and acupuncture. Discussion: The overall quality of current research in acute stroke rehabilitation is moderate with many studies demonstrating questionable reliability, validity and generalizability. This analysis focused on higher-level systematic reviews and meta-analyses of current stroke research to determine which intervention or combination of interventions were most effective in acute stroke gait training. This analysis found a general consensus that an intense, individualized combination of the above interventions is most effective, affordable and safe in acute stroke gait training. More high-quality research is needed involving similar stroke patient demographics, research designs, and outcome measures to further investigate intervention effects and to determine consistent, accepted parameters and protocols for optimal acute stroke rehabilitation.
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Gait Training, Acute stroke, Stroke Rehabilitation, Functional Electrical Stimulation, Treadmill Training
Benjamin, Corinna M.. "Gait Training in Acute Stroke: A Case Study and Evidence-Based Literature Analysis." (2015). http://digitalrepository.unm.edu/dpt/121