Effect of Duration of Upper- and Lower-Extremity Rehabilitation Sessions and Walking Speed on Recovery of Interlimb Coordination in Hemiplegic Gait
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Background and Purpose. The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Subjects and Methods. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 1½-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Results. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. Discussion and Conclusion. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.
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Larger stride lengths on the nonparetic side contributed more to observed improvements in comfortable and maximal walking speed than measured kinematic changes on the paretic side in 53 patients with stroke.
“Kwakkel et al 77 showed in 53 patients with stroke that larger stride lengths on the nonparetic side contributed more to observed improvements in comfortable and maximal walking speed than measured kinematic changes on the paretic side.77”
From The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? (2009) · cites this paper as [77]
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- Authors
- Kwakkel, G., & Wagenaar, R. C.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Boston University (US)
- Corresponding author
- Kwakkel, Gert
- Venue
- Physical Therapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-05-01
- Volume
- 82
- Issue
- 5
- Pages
- 432-448
- ISSN
- 0031-9023 (ISSN-L)
- 1538-6724
- OpenAlex
- W2133313548
- Cited by
- 143
- References
- 60
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 6 · 2019: 7 · 2018: 2 · 2017: 7 · 2016: 7 · 2015: 1 · 2014: 12 · 2013: 5 · 2012: 13
- FWCI
- 8.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.scopus.com
- Licence
- other-oa
- Locations
- Physical Therapy (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Keywords
- stroke rehabilitation, hemiplegic gait, interlimb coordination, walking speed, upper limb rehabilitation, lower limb rehabilitation, middle cerebral artery stroke, continuous relative phase, gait asymmetry, activities of daily living training
- MeSH terms
- Stroke Rehabilitation, Analysis of Variance, Arm, Biomechanical Phenomena, Data Interpretation, Statistical, Female, Follow-Up Studies, Gait, Hemiplegia, Humans, Immobilization, Leg, Male, Middle Aged, Models, Theoretical, Posture, Pressure, Splints, Time Factors, Walking, Physical Therapy Modalities
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