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Gait Training After Stroke: A Pilot Study Combining a Gravity-Balanced Orthosis, Functional Electrical Stimulation, and Visual Feedback

Krishnamoorthy, Vijaya PT, PhD; Hsu, Wei-Li PT, PhD; Kesar, Trisha M. MS, PT; Benoit, Daniel L. PhD; Banala, Sai K. PhD; Perumal, Ramu PhD; Sangwan, Vivek BTech; Binder-Macleod, Stuart A. PT, PhD, FAPTA; Agrawal, Sunil K. PhD; Scholz, John P. PT, PhD

Journal of Neurologic Physical Therapy: December 2008 - Volume 32 - Issue 4 - pp 192-202
doi: 10.1097/NPT.0b013e31818e8fc2
Case Report

Rationale: This case report describes the application of a novel gait retraining approach to an individual with poststroke hemiparesis. The rehabilitation protocol combined a specially designed leg orthosis (the gravity-balanced orthosis), treadmill walking, and functional electrical stimulation to the ankle muscles with the application of motor learning principles.

Case: The participant was a 58-year-old man who had a stroke more than three years before the intervention. He underwent gait retraining over a period of five weeks for a total of 15 sessions during which the gravity compensation provided by the gravity-balanced orthosis and visual feedback about walking performance was gradually reduced.

Outcomes: At the end of five weeks, he decreased the time required to complete the Timed Up and Go test; his gait speed increased during overground walking; gait was more symmetrical; stride length, hip and knee joint excursions on the affected side increased. Except for gait symmetry, all other improvements were maintained one month post-intervention.

Conclusions: This case report describes possible advantages of judiciously combining different treatment techniques in improving the gait of chronic stroke survivors. Further studies are planned to evaluate the effectiveness of different components of this training in both the subacute and chronic stages of stroke recovery.

Physical Therapy Department (V.K., W.-L.H., T.M.K., R.P., S.A.B.-M., J.P.S.), Mechanical Engineering Department (D.L.B., S.K.B., V.S., S.K.A.), Biomechanics and Movement Science Program (W.-L.H., T.M.K., S.A.B.-M., S.K.A., J.P.S.), and Center for Biomedical Engineering Research (R.P., S.A.B.-M., S.K.A., J.P.S.), University of Delaware, Newark, Delaware.

Supplemental information (videos) for this article can be found at

Vijaya Krishnamoorthy is currently at the Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia.

Daniel L. Benoit is currently at the School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.

Wei-Li Hsu is currently at the Institute of Neuroscience, University of Oregon, Eugene, Oregon.

Address correspondence to: John P. Scholz, E-mail:

© 2008 Neurology Section, APTA