Gait analysis outcome following physiotherapy based on the Bobath concept in patients post-stroke

Abstract

Introduction: In the present study physiotherapy based on the Bobath concept, applied to patients post-stroke with balance and gait problems, was evaluated. Facilitation of selective control of movement, achieved by the re-education of basic movement patterns is a key feature of the approach. The hypothesis was that normal movements patterns would be restored: working proximally would improve distal control and the weight-bearing ability of the hemiplegic leg would increase. Materials and methods: 11 hemiplegic patients (3 females and 8males; the average age was 59 years) participated in this study. A total of 9 trials each patients were carried out using the EL.I.TE. 3-D SMART opto-electronic system (BTS, Milan, Italy) following DAVIS protocol. EMG (Pocket EMG, BTS, Milan, Italy) signals from gluteus medius (MG), rectus femoris (RF), biceps femoris (BF), vastus medialis (VM), vastus lateralis (VL), soleus (SL), gastrocnemius medialis (GM) and tibialis anterior (TA) were recorded. Two dynamometric platforms permitted the measurement of the joint moments and the mechanical energy produced. An important aspect of the Bobath concept is the treatment of tone anomalies [1]. The therapists identified the following problems based on their assessment: reduced selective control of the pelvis, reduced selective control of the lower extremity, and increased tone. The patients had physiotherapy for one hour a day, five times a week [2]. Outcome measurements were obtained within three weeks after the completion of the rehabilitation period. Results: Before and after physiotherapy we monitored the following parameters which were significant of the effectiveness of the treatment. Kinematics on the affected side: a reduced pelvic obliquity (Fig. 1) with better hip and knee extension during stance. Kinetics on the affected side: increase of the abductor (Fig. 2) and extensor moment peak at hip, with a respectively average value of 0.9 Newton x meter/kg, against 0.6 of the pre-treatment controls and 0.7 Newton x meter/kg, against 0.4 of the pre-treatment con-(Figure presented) trols; increase of power generation at the ankle at push off with average value of 0.7 Watt/kg, against 0.4 of the pre-treatment. Dynamic electromyography recorded a correct activation at the expense of the gluteus medius during the mid-stance. This is associated with reduced adductors interference. Discussion: The importance of selective trunk activity in the rehabilitation of the hemiplegic patient is very important also for walking. The field of motor control, supported by the gait analysis is directed to study the nature of movement and how the movement is controlled. These two points are very important to improve the performance of physiotherapy and work towards an improvement of the function. In this study the therapists worked on gait specific practice, with time devoted to generating hip extensor and abductor activity during gait in patients showing improvements in hip flexor and ankle plantarflexor power bursts. Key variables to detect changes in weight transfer need to be identified. The results indicate that physiotherapy treatment based on the Bobath concept may influence the gait pattern in patients with hemiplegia following a cerebrovascular accident [3]. This report suggests that changes in movement patterns can be documented when outcome measures linked to the aims of therapy are selected.