Movement quality in post-stroke walking. An observational study of physiotherapy practice

Purpose: Increased insight in physiotherapy practice regarding recovery of walking function in the early post-stroke phase, with particular attention to any changes in movement quality. Design, Material and Method: Non-participatory observation of one physical therapist in interaction with two strategically selected patients admitted to a stroke unit and with walking difficulties because of various neurological outcome. A systematic content analysis was carried out based on a phenomenological-hermeneutic approach. Theory of science/neurobiology and clinical reasoning were used as analytical perspectives. Results: The physiotherapist draws attention towards quality of movement and emphasizes aspects such as; adaptation to the base of support and surroundings, postural control and relationship between stability/mobility in different body parts. Changes in movement quality are observed in both situations and occurs both in part-functions and in walking. Most of the time her actions target part-tasks and part-functions, while walking is performed intermittently. The physical therapist continuously adjusts her interaction and tasks/activities in the situations. The adjustments seem to be based on analysis of individual structural and functional constraints, as well as evaluation of emotional needs of the situation. Conclusion: The physical therapists actions are adjusted to the individual patients specific needs. Changes in movement quality at impairment-level seem to be of significance for changes in movement quality in walking. The individualized approach and problem solving appear essential for the qualitative changes that occur during treatment and in walking.