[Biomechanical approaches in correction of gait in post-stroke hemiparesis].

Abstract

Neurorehabilitation of post-stroke motor disorders is a relevant and rapidly developing area in modern medicine. Timely correction of the developing pathological gait stereotype is an important task for a physician of physical and rehabilitation medicine. Identification of the central defect in the biomechanics of gait and targeted impact on it using various rehabilitation methods makes it possible to restore the gait function in a patient with post-stroke hemiparesis more effectively.

Objective: To evaluate the effects of rehabilitation using author's technique of shifting the center of gravity of the foot on gait biomechanics in patients with post-stroke hemiparesis.

Material and methods: This article studies a variant of rehabilitation effect on the pathological gait stereotype caused by the violation of the forward outreach of the paretic leg using author's technique of shifting the center of gravity of the foot developed on the basis of the Department of Nervous Diseases of the Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University. A pilot study was carried out with participation of 15 patients undergoing rehabilitation at the 2nd stage in the medical rehabilitation departments No. 2 and 3 of the Federal Siberian Research Clinical Centre under FMBA of Russia (FSRCC FMBA of Russia) in Krasnoyarsk. The patients underwent gait training sessions using technique of shifting the center of gravity of the foot according to the scheme of 10 daily sessions with the duration of 20-40 minutes per day. The function of gait was assessed using the ichnography method.

Results: A comparison of gait function before and after rehabilitation was conducted using the Wilcoxon p-test. The median of the step length of the paretic leg before sessions was 34.31 cm, after sessions 44.84 cm (p<0.01), the median of the step asymmetry, that is, the difference in the step length of the paretic and intact leg, before sessions, was 11.77 cm, after sessions 6.35 cm (p<0.01). Significant improvements in the main spatial parameters of step were obtained against the background of rehabilitation using technique of shifting the center of gravity of the foot.

Conclusion: Training using technique of shifting the center of gravity of the foot improves the function of gait and may be used as a method of motor rehabilitation for patients with post-stroke hemiparesis.