PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2015

Clinical Scenario

My patient was an 80-year-old gentleman who was admitted to the inpatient rehabilitation unit one week after sustaining a right cerebral vascular accident (CVA). He presented with impairments including right-sided weakness, left-sided inattention and left visual field cut. He was able to ambulate five steps in the parallel bars with moderate assistance. The patient had been admitted seven days prior when his wife brought him into the Emergency Department with slurred speech. Tissue Plasminogen Activator (TPA) was administered shortly after his arrival at the hospital. The patient’s wife reported this was his first stroke.

Clinical Question

Does NDT increase the quality of gait in individuals who have had a recent stroke greater than standard physical therapy including treadmill walking and task specific exercises?

Clinical Bottom Line

Based on the results of Vliet et al, Eich et al, Brock et al, and Dias et al, there is moderate evidence to say that NDT is equally as effective as standard therapy in individuals who have sustained their first stroke in the previous year or less in improving gait quality, ability to perform pre-gait activities, and balance. NDT and all of the comparison methods produced relatively significant within group results with scattered between group differences. Treatment initiation ranged from two weeks to 12 months post- stroke and treatments lasted from two weeks to six weeks. Results from the treatments tended to be equally effective in the range of chronicity of stroke. Outcomes used to reach this conclusion were the Berg Balance Scale, Rivermead Motor Assessment, Rivermead Motor Index, Movement Assessment Scale, six minute walk test, and ten meter walk test, all of which were found to be reliable and valid measures.

All studies had good to fair internal validity. Threats across the board included lack of therapist and subject blinding. External validity was fair overall as most of the studies were initiated greater than two weeks after initial stroke diagnosis when inpatient rehabilitation would usually occur. Most of the NDT treatments were not described in enough detail for a clinician to reproduce the techniques. Also, most studies had small sample sizes with limited power, reducing the ability to generalize to other individuals one-week post CVA.

On a cost benefit analysis NDT certification requires a significant amount of therapist time but is not as expensive as the initial purchase of a treadmill or gait trainer equipment (British Bobath Tutors Association, 2014). Most the studies were feasible with insurance reimbursement in an acute rehabilitation unit, and feasible for patients as well. Treatments were found to be safe with no adverse reactions reported. Three out of the four studies had high subject retention indicating patients found participating tolerable in general.

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