This paper reports the in-patient rehabilitation admission and discharge scores on a comprehensive series of balance and mobility measures for 109 stroke patients (49.5 per cent female) with a mean (SD) age of 72.9 (10.4). The results reflect good outcomes regarding discharge destination (77 per cent discharged to own or families' home), and all balance and mobility measures improved significantly during rehabilitation (p<0.05). However, when performance at discharge was compared with values reported for healthy older people, the dynamic balance and mobility measures identified marked residual problems. Only 7 per cent of patients met all four criteria defined for independent community ambulation. These results are discussed in the context of modifying clinical practice to improve community ambulation outcomes for stroke patients.
The findings suggest that a clinically useful and responsive balance and mobility test battery should include one component of the CTSIB (Shumway-Cook & Horak, 1986), RR (step stance), ST and gait velocity.
The challenge of rehabilitating young, healthy transfemoral amputees may extend beyond the boundaries of teaching them to adapt to functional activities of daily living. The goal for several of these amputees is to participate and sometimes even compete in recreational activities, including running. These amputee runners require prosthetic adaptations as well as a comprehensive individualized training programme to ensure that their running is as safe and energy efficient as possible. To help amputees achieve this, clinicians must understand normal and prosthetic locomotion. This paper compares the biomechanical differences between walking and running in normal locomotion and analyses the running modes used by transfemoral amputees. The modified running mode achieved with the Terry Fox Running Prosthesis subjectively “looks” more energy efficient to the observer and “feels” more energy efficient to the user. These assumptions have yet to be confirmed or refuted by a rigorous scientific research study. An outline of the proposed physiotherapy protocol includes the familiarization, treatment, and training phases. Physiotherapists involved in amputation rehabilitation may not be commonly confronted with this level of patient expectation. It is their responsibility to give realistic guidance to these amputees so that they can safely and independently pursue their recreational running activities. This need can best be fulfilled by providing sound clinical advice which has been validated by research findings.
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