national-clinical-guidelines-for-stroke-fourth-edition

epetitively. Treadmills have not been shown to be of any greater benefit than
conventional physiotherapy intervention. Stroke patients may choose to use a walking
aid to help them practise walking earlier rather than waiting until they can walk without
one (Tyson and Rogerson 2009). The use of a walking stick for balance (ie light touch)
seems to produce better results than use of a stick for weight bearing (Boonsinsukh et al
2009).
6.8.1 Recommendations
A Every patient who has limited mobility following stroke should be assessed by a
specialist in neurological physiotherapy to guide management.
B Patients with limited mobility should be assessed for, provided with and taught how
to use appropriate mobility aids (including a wheelchair) to facilitate safe
independent mobility.
C People who are able to walk with or without assistance should undergo walking
training to improve endurance and speed.
D An ankle–foot orthosis should only be used to improve walking and/or balance, and
should be:
6.8.2 Sources
● tried in patients with foot-drop (reduced ability to dorsiflex the foot during
walking) that impedes safe and efficient walking
● evaluated on an individual patient basis before long-term use
● individually fitted.
A Consensus
B Laufer 2002; Singh et al 2006; Boonsinsukh et al 2009; consensus
C Jorgensen et al 2010; van de Port et al 2007
D de Wit et al 2004; Pohl et al 2006; Tyson and Rogerson 2009
6.8.3 Implications
6 Recovery phase from impairments and limited activities: rehabilitation
All stroke services should have therapists who are knowledgeable about the use of aids
and appliances to improve function after stroke, and have easy access to a well resourced
wheelchair and orthotics service.
6.9 Balance impairment and risk of falling: assessment and intervention
Many patients experience reduced balance control after stroke, usually due to a
combination of reduced limb and trunk motor control, altered sensation of one side
and, sometimes, centrally determined alteration in body representation such that the
person misperceives their posture in relation to upright. Whatever its cause, impaired
balance is important because it reduces confidence and increases the risk of falls.
This section covers interventions other than biofeedback which is covered in section
6.12.
© Royal College of Physicians 2012 85