Gait re-education following stroke: The application of motor skills acquisition theory

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Abstract
It is known that the demand for physiotherapy to treat disability arising from stroke is considerable. In particular, the functional importance of walking renders the re-education of this competency a priority. However, current techniques of treatment tend to be expensive and time consuming, raising questions concerning their cost-effectiveness. Similarly, as a result of the high demand, treatment for many stroke patients may be discontinued before they have reached their full functional recovery. The need to address these problems by reconsidering the way in which physiotherapy is delivered is, therefore, of considerable importance. This paper proposes the application of principles from the body of knowledge related to motor skills acquisition to the treatment of gait following stroke. It is suggested that the role of the physiotherapist is to control the direction of normal central nervous system recovery, thus assisting the patient to regain lost function. The application of demonstration, practice variables and augmented feedback, which are known to influence skills acquisition, should enhance the effect of current physiotherapy procedures. Similarly, delegation of practice supervision while the patient is not receiving physiotherapy would appear to be essential in ensuring the thorough acquisition of the motor competency so that it will be useful in a variety of functional scenarios. In this regard, the role of the physiotherapist as an educator assumes greater significance. By employing techniques which will enhance motor skills acquisition in each of the three stages of motor learning, it is proposed that the re-education of gait will be more successful and will enable physiotherapists to apply treatment to stroke patients for much longer periods of time than at present. In addition, the application of the motor skills acquisition paradigm as a research direction appears to hold considerable promise.

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