Withdrawal reflex-based gait training in the subacute post-stroke phase: Preliminary results

Abstract

The aim of this study was to investigate the feasibility of using nociceptive withdrawal reflexes (NWR) to support gait training in the subacute post-stroke phase. Thirty hemiparetic individuals were randomly divided into: 1) a group that received intensive physiotherapy-based gait training supported by electrical stimulations that triggered the NWR during late stance, and 2) a control group that received intensive physiotherapy-based gait training alone. Both groups received 4 weeks of gait therapy. Electrical stimuli were delivered at the arch of the foot at heel-off with the purpose of eliciting the NWR and thereby support the initiation and execution of the swing phase. Gait was assessed by the Functional Ambulation Category (FAC) test and by the duration of the gait cycle and the stance phase in the hemiparetic side before treatment, immediately after, and one month after finishing treatment. Subjects in both groups showed an improvement in their walking ability, though those who received physiotherapy-based gait training supported by NWR stimulation had a tendency to score better in the FAC-test. Individuals who at inclusion presented severe walking impairments (FAC scores 0 and 1) showed the best improvement as evidenced by a longer duration of the stance phase in the hemiparetic side and a shorter duration of the gait cycle resulting in a pattern closer to normal gait. Intensive physiotherapy training combined with electrical stimulation to evoke a NWR that supports the initiation and production of the swing phase seemed to improve the general walking ability of subacute hemiparetic patients. Strong sensory stimulation seems to be useful in the rehabilitation of the hemiparetic gait. © 2011 Springer-Verlag.