Evaluation and re-education of gait following stroke

Abstract

This review looks critically at some of the literature concerning the problems of evaluation and re-education of gait following stroke. Fifteen studies into methods of evaluation are reviewed and the parameters of gait considered in each study have been grouped into four categories: EMG activity and joint movement; limb loading; time/distance parameters; and energy cost. The review highlights the difficulty in developing methods of evaluation that are reliable and easy to perform in the clinical setting and that measure appropriate parameters. Nine studies into the efficacy of different approaches to the re-education of gait are reviewed, six being concerned with the use of biofeedback, two with Functional Electrical Stimulation and one with an exercise/movement regime. They show the difficulties in setting up clinical trials in physiotherapy, in particular due to the imprecise nature of the treatment approaches and they reveal the lack of scientific evidence of efficacy. It is suggested that an evaluation of efficacy is needed and that it could best be undertaken by first studying the physiological bases to the approaches before attempting to set up clinical trials using appropriate and reliable methods of evaluation.