The Effect of Early Stand-up and Gait Exercise for Severe Hemiplegic Patients after Stroke

―Investigation at One Month after the Start of Exercise―

Abstract

The purpose of this study was to investigate the effect of early stand-up and gait exercise for severe hemiplegic patients after stroke one month after the start of physical therapy (PT). The subjects were twenty-eight severe hemiplegic patients in the acute phase after stroke. We selected patients who met after two criteria during the time from the onset of stroke to the start of PT ; (1) patients who needed total assistance when performed all basic movements, including side sitting, and (2) patients whose Brunnstrom stage of their affected lower extremity was less than stage II. We divided these subjects randomly into two groups which included fourteen subjects respectively ; one was the early group which received early stand-up and gait exercise consisted of assistive gait exercise and repeated stand-up and sit-down exercise, the other was the control group which received conventional PT for hemiplegic patients. PT for both group was started as soon as possible after the onset of stroke. We compared the early group with the control group from the standpoint of the improvement in Brunnstrom stage of affected lower extremity, Barthel Index (BI) and the degree of independence of basic movements ; rolling over, rising, side sitting, standing, transfer activity between wheelchair and bed, and gait one month after the start of PT. No significant difference in improvement of Brunnstrom stage of affected lower extremity was demonstrated between both groups. However, improvement in BI and the degree of independence of basic movements except gait in the early group was more marked than that in the control group. These results suggest that early stand-up and gait exercise might be more effective PT regime than conventional PT for severe hemiplegic patients after stroke.