Some Clinical And Psychosocial Determinants Of Independent Walking Attainment By Post Stroke Patients

Background It is not uncommon for post stroke patients or their caregivers to ask the attending physiotherapist when the patient would regain ability to walk. This is often difficult to predict as many clinical and non-clinical factors influence when this function is accomplished. Objective To investigate the influence of some clinical and psychosocial factors on the time post stroke individuals commence independent walking. Methods The one-group, pre-experimental study carried out in a teaching hospital facility involved 27 (14 males and 13 females) fully conscious, unilateral, first-episode stroke patients admitted to the facility and referred for physiotherapy over 5 months. A daily, structured physiotherapy care including Bobath technique was administered on the patients for 12 weeks. Ages, marital status, years of formal education, occupation, personality type (Eysenck classification), level of disability, co-morbid factors and admission-referral interval were obtained. Main outcome measure was time taken to attain ability to walk a continuous, level floor 10m distance unaided. Results The mean time independent walking was attained was 7.4 ± 2.6 weeks. Participants with mild disability level at baseline commenced independent walking significantly earlier (4.00 ± 0.01 weeks) than those with moderate disability (7.72 ± 2.53 weeks). Independent walking attainment time showed no significant difference (p>0.05) across the psychosocial factors. A significant relationship were found between age (r = - 0.57), functional independence measure (r = - 0.55) and commencement of independent walking. Conclusion Age and the initial level of disability had significant influence on commencement of independent walking by the participants. Introduction Il n\'est pas inhabituel pour les patients victimes d\'un accident vasculaire cerebral (AVC) et pour leur soignants, de demander aux reeducateurs fonctionnels le delais permettant la reprise de la marche. Ce delai est souvent difficile a prevoir compte tenu des facteurs multiples, a la fois cliniques et non cliniques intervenant dans cette fonction motrice. Objectif L\'objectif est de definir quelques facteurs cliniques et psychologiques influencant la duree de recuperation post-AVC permettant l\'autonomie de la marche. Methodes Un groupe preliminaire a ete etudie dans un centre hospitalier universitaire et concernaient 27 patients (17 mâles et 13 de sexe feminin) conscients, presentant un deficit unilateral apres un premier episode d\'accident vasculaire. Il ont ete suivis dans un centre de physiotherapie durant cinq mois. Une prise en charge quotidienne incluant la technique de Bobath a ete instituee pendant douze semaines. Les parametres suivants ont ete etudies : âge, statut marital, niveau de formation et d\'education, profession, personnalite (classification d\'Eysenck), degre d\'invalidite, facteurs de co-morbidite, et de delai de prise en charge. La principale mesure attestant de la capacite a marcher de maniere continue a ete une marche continue, sur distance plane de 10 metres, sans aide. Resultats Le temps moyen de reprise de la marche sans aide etait de 7.4 ± 2.6 semaines. Les patients avec un handicap moyen ont eu une recuperation plus precoce modere (4.00 ±0.01 semaines) que ceux qui avaient un handicap (7.72 ± 2.53 semaines). Les facteurs psychosociaux n\'etaient pas significatifs (p>0.05). Une relation a ete objectivee entre l\'âge (r = - 0.57), le degre d\'independance (r = - 0.55), et le debut de la marche de maniere autonome. Conclusion L\'âge et le degre d\'invalidite avaient une influence significative sur le delai de reprise d\'une marche autonome. Keywords : Africa, Independent Walking, Psychosocial, Stroke African Journal of Neurological Sciences Vol. 25 (1) 2006: pp. 59-66