Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke

Purpose. The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. Methods. Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy ( mean duration 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. Results. Recovery of more normal gait patterns in the gait cycle ( using motion analysis) did not occur. Significant changes in temporal parameters ( loading response, single support time) for both legs, in one kinematic ( dorsiflexion during stance) and one kinetic variable on the unaffected side ( hip flexor moment), and most of the clinical measures of impairment, activity and participation ( with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. Conclusions. Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.