Objective: To describe and examine the feasibility of a new treatment approach for the paretic lower limb and to explore its effectiveness in one chronic hemiparetic stroke subject.
Design: Case report. The treatment was conducted three times per week over a period of six weeks. The mobility of the patient was assessed prior to the treatment, at the end of the treatment and at a six-week follow-up.
Settings: The study was carried out at the research centre of the Institut de réadaptation de Montréal. The treating therapist was an experienced rehabilitation professional as was the assessor, who worked at a different rehabilitation centre.
Interventions: The motor re-education programme was based on the use of a static dynamometer that measures the linear external forces produced at the ankle level. A computer program provided the subject with constant feedback on the direction and intensity of the applied force. In each treatment session, the subject was asked to produce several submaximal efforts in 16 specific directions. Both the intensity and the number of repetitions were gradually increased.
Outcome measures: In addition to force production measurements, three clinical assessments of mobility were used: the Timed 'Up and Go', the comfortable gait speed and a 2-minute walk test.
Results: The maximal static linear forces produced by the subject increased through the treatment for all directions of effort, but differences were observed amongst directions. During the treatment programme, the subject improved his performance at the three clinical assessments. Even if some of the functional gain was lost at the follow-up, the mobility was still considerably improved as compared to baseline values.
Conclusion: This study demonstrated the applicability of the treatment programme to a stroke subject. The results seem very promising and encourage further investigation in order to assess more rigorously the effectiveness of this new approach.