Profoundly impaired mobility is a major consequence of stroke. As a result, a large number of more than 700,000 people in America sustaining a stroke each year have limitations in motor ability and compromised quality of life. It is a fact that individuals with hemiparesis frequently bear the majority of their body weight through their uninvolved lower extremity. Asymmetry of stance and weight bearing has been recognized as a predictor of the ability to ambulate.  Therefore, achieving symmetry of stance and gait is considered an important goal of rehabilitation. However, therapeutic interventions designed to enhance motor function and promote independence following stroke are quite limited. We have developed a new technique that preliminary studies suggest can substantially improve gait pattern, reduce the incapacitating motor deficit of stroke patients, and increase their independence. The technique, termed Compelled Body-Weight Shift (CBWS) therapy, involves lift of the nonaffected lower extremity through the use of a shoe insert over a period of several weeks. During this time, more symmetrical weight bearing is facilitated while patients participate in physical therapy as well as regular daily activities. The proposed research builds on findings from a pilot study that demonstrated significant gains in individuals with chronic unilateral stroke following CBWS therapy. The experimental design randomly assigns patients who are more than 1 year post-stroke to two groups. The experimental group will receive CBWS therapy combined with conventional physical therapy for a period of six weeks, the control group will only receive conventional physical therapy. Immediate and longer-term (four months out) results from both groups will be compared. The specific aims are: (1) to test the efficacy of CBWS therapy compared to conventional therapy alone in improving gait and symmetry of weight bearing; (2) to evaluate whether the improvement is sustained post-CBWS therapy. This research is of paramount significance because, if successful, the outcomes from the study could be used to refocus conventional rehabilitation strategies aimed at helping chronic stroke patients to achieve maximal independence in mobility and activities of daily living.

(NIH Grant HD 050457)

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