[ARTICLE] Effect of Exercise on Gait Mechanics in a Patient with Severe Gait Disorder Due to Chronic Ischaemic Stroke: A Case Study – Full Text

ABSTRACT

We describe the effects of an exercise programme based on the American Heart Association and American Stroke Association guidelines for stroke patients on gait mechanics in a patient with severe gait disorder due to chronic ischaemic stroke. A 74-year-old female patient, with right hemiparesis as a result of a stroke attack before 18 months followed an 8-week exercise programme, consisting of three hourly sessions per week. Patient’s gait mechanics were evaluated before and after the intervention using a three-dimensional gait analysis system, with six infrared cameras, two force plates, and an electronic timing system. Exercise led to increase of spatial and decrease of temporal gait parameters, increase of joint range of motion and lower limb muscle powers during the entire gait cycle and increase of the moments in the support phase. In conclusion, exercise had a positive effect on this patient’s gait pattern and improved her functionality.

1. Introduction

Stroke is the most common cause of serious long-term disability [1] . Although the rate of neurological recovery is rapid in the first 4 weeks after the stroke [2] , functionality improvement seems to extend beyond this period, possibly through the development of compensatory strategies against neurological deficits [3] . However, patients often adopt a sedentary lifestyle that leads to dependence on other people, but also to increased risk of falls and recurrence of stroke [4] , or other cardiovascular events [5] [6] . In particular, patients after stroke are significantly less physically active in comparison with the elderly who suffer from chronic musculoskeletal diseases or other cardiovascular diseases [7] [8] [9] [10] . A sedentary lifestyle exacerbates further their cardiovascular function and the already impaired functional capacity [11] [12] . Furthermore, it leads to increased fatigue, muscle atrophy and weakness, osteoporosis and impaired circulation in the lower limbs. Finally, the greater dependence of patients with stroke on others for daily activities and their impaired ability for usual social activities can have serious negative psychological effects [13] .

In 2014, the American Heart Association and American Stroke Association (AHA/ASΑ) published the revised recommendations on exercise in patients with stroke [14] . Nevertheless, to the best of our knowledge, there is no data concerning the effect of the above exercise programme on patients’ gait pattern. Importantly, gait pattern affects muscle and joint loads during movement and thus on the long-term function of the skeletal system [15] [16] [17] . We herein describe the effect of an exercise programme based on these recommendations on gait mechanics in a patient with severe gait disorder resulting from an ischaemic stroke in the chronic phase of rehabilitation.

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