Community Ambulation: Clinical Criteria for Therapists? Reasoning and Decision-making in Stroke Rehabilitation

Abstract

Copyright: © 2013 Oh DW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In stroke rehabilitation, walking function is critical to maintaining functional independence and improving daily activity levels, and is strongly associated with the quality of life post-stroke. Functional improvement should be prioritized when establishing the therapeutic strategy and selecting the means of treatment for patients with poststroke hemiparesis. Accordingly, most clinicians recognize the recovery of walking function as the main goal in stroke rehabilitation [1]. This may be the essential criterion in the decision to discharge a patient from the initial care clinic or hospital to return to home life [2]. In general, the walking function of stroke patients has been assessed using clinicbased measurements. However, as environmental structures within clinics and hospitals are designed with functionally impaired patients in mind, this may not accurately reflect their ability for community ambulation. Although most patients can walk independently after a rehabilitation course for post-stroke functional problems, they have difficulty in returning to premorbid life [3], and only a few patients can perform community ambulation without any trouble [4]. In general, patients with post-stroke hemiparesis use aids such as a cane or walker to compensate their impaired walking function. However, increased dependency on walking aids aggravates body asymmetry and functional problems over time.