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KMID : 1034620170070010061
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Korean Journal of Neuromuscular Rehabilitation
2017 Volume.7 No. 1 p.61 ~ p.85
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Therapeutic Strategy for Improving Ambulatory Function in Patients with Chronic Stroke : Literature Review
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Oh Duck-Won
Won Sang-Hee
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Abstract
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Following stroke, long-lasting symptoms require specific procedures to improve functional level in everyday life, with aiming of assuring independent daily activities. Based on this principle, the recovery of ambulatory capacity is one of the most important objectives in stroke rehabilitation. Recently, a progress in scientific knowledge highlights neuromechanical approaches and applied technologies (robot-assisted walking system and functional electrical stimulation) to support functional recovery of patients with post-stroke hemiparesis. Although various therapeutic techniques for stroke rehabilitation have successfully used in clinical setting, such techniques are kinds of different and contradict each other in many way. Given that their effects have been reported to be similar, major principles in stroke rehabilitation approaches often cannot be obviously illustrated for clinical use. Recent knowledge has introduced two ways to improve functional disability of stroke patients: Bottom-up and top-down. In general, conventional approaches, including Bobath and proprioceptive neuromuscular facilitation, may be characterized by the bottom-up approach, while top-down approach can be described by the use of task-oriented training focusing on functional training based on principles of motor learning. In stroke rehabilitation, recent consensus highlights functional aspects of the patients and reintegration to premorbid life, and then top-down approach focusing on the effects of functional training supports current prospective to manage their own symptoms and functional disability. However, the effects of musculoskeletal disparity after stroke have not been in full consideration, even though joint malalignment and muscle imbalance is one of major contributing factors to impede normal movement patterns. Such fact indicates that a combination of top-down approaches and musculoskeletal techniques to facilitate normal movement is better alternative to support functional improvement in stroke rehabilitation. Therefore, introduction of novel concepts needs to establish appropriate clinical reasoning and decision-making strategies for stroke rehabilitation in future. This study aimed to demonstrate comprehensive knowledge related to neurophysiological mechanism and therapeutic approaches to improve walking function of patients with post-stroke hemiparesis.
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KEYWORD
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Function, Stroke, Walking
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