Age and Ageing, Vol 29, 311-318, Copyright © 2000 by British Geriatrics Society
R Liston, J Mickelborough, B Harris, A Hann and R Tallis
Objectives: to compare the therapeutic effects of two
approaches to gait re-training - a schedule of conventional physiotherapy
and treadmill re-training - in patients with higher-level gait disorders
associated with cerebral multi-infarct states.Design:
single-blind crossover study involving a 4-week baseline period, 4 weeks of
treadmill re-training and 4 weeks of conventional
physiotherapy.Setting: a large teaching
hospital.Subjects: patients with cerebral
multi-infarct states who met the criteria for higher-level gait disorders.
Computed tomographic brain scans showed at least one large vessel infarct,
basal ganglia and white matter lacunes or extensive
leukoaraiosis.Interventions: a schedule of treadmill
re-training and a specific schedule of physiotherapy containing 31
interventions in three treatment modules: (i) for gait ignition failure and
turning; (ii) to improve postural alignment and enhance balance reactions;
and (iii) for other components of cerebral multi-infarct state disordered
gait.Main outcome measures: spatial and temporal gait
measures and activity of daily-living
assessments.Results: we recruited 18 patients, mean
(SD) age 79.1 (6.8) years. Patients walked an average of 7.9 (5.5) km on
the treadmill and had an average of 6.7 (3.2) h of physiotherapy. There
were clinically moderate but highly statistically significant
(P < 0.001) improvements, in the following
indices: time taken to complete the sit-to-stand test; time taken to walk
10 m; number of steps over 10 m; walking velocity; right and left step
lengths; and time taken to complete the 'S' test. There were no differences
in the results obtained in each limb of the
study.Conclusion: there is no difference between the
effects of conventional physiotherapy and treadmill re-training on the gait
of patients with higher-level gait disorders associated with cerebral
multi-infarct states. However, the improvements seen during the treatment
period suggest that there is scope to improve the gait of this group of
frail, elderly patients.Keywords: gait re-training,
multi-infarct gait disorder, physiotherapy, treadmill
ARTICLES
Conventional physiotherapy and treadmill re-training for higher-level gait disorders in cerebrovascular disease
Department of Geriatric Medicine, Clinical Sciences Building, Hope Hospital, Eccles Old Road, Salford M6 8HD, UK; Corresponding author; e-mail: rtallis@fs1.ho.man.ac.uk
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