Hemiparetic gait following stroke. Part II: Recovery and physical therapy

This part begins with a review of locomotor recovery following stroke as revealed by clinical measures. These describe a recovery curve with a rapid rise within the first 6 weeks when active rehabilitation procedures supplement natural recovery, followed by a more gradual rise thereafter to plateau at about 6 months after stroke. The sensitivity of these clinical measures is questioned for more advanced stages of recovery since gait velocity and other quantitative EMG and movement variables reveal changes indicative of recovery up to 2 years after stroke. A review is then made, from the traditional to the most recent, of physical-therapy approaches used to promote locomotor recovery. Therapy choice for different types of disturbed motor control is briefly discussed. The need for the development of new therapeutic strategies based on current science is emphasized as is the use of sensitive outcome measures and appropriate study designs to evaluate therapy efficacy.