Weight bearing on the affected lower limb in residents of a geriatric rehabilitation hospital

Objectives: The purpose of the study was to determine whether and to what extent the treatment goal of enhancement of weight bearing on an affected lower limb is achieved in the gait rehabilitation of patients with poststroke hemiparesis, postprosthetic fitting due to unilateral transtibial amputation, or postunilateral hip or knee arthroplasty. Design: Nonrandomized prepost study. Subjects were 26 residents of a geriatric rehabilitation hospital in the initial stage of gait rehabilitation after poststroke hemiparesis (n = 9), unilateral total hip or knee joint replacement (n = 11), or unilateral transtibial amputation with a fitted prosthesis (n = 6). Weight bearing on the hindfoot and forefoot of the affected limb was measured by using the SmartStep system version 2.2.0, at least once a week, both before and immediately after a gait-training session. Measurements were performed with the patients using their assistive devices. Results: In the patients with hemiparesis, there was no significant difference found between the initial pretraining maximal weight bearing on the afflicted limb (39% and 50% of body weight on the hindfoot and forefoot, respectively) and that at discharge (47% and 50% of body weight, respectively). In patients after hip or knee arthroplasty and in those who underwent prosthetic fitting, there was a substantial increase found in the loading of the forefoot, but not of the hindfoot, from the initial evaluation to the time of discharge (from 43% to 54% of body weight, P = 0.05, in the arthroplasty group, and from 49.6% to 69.5%, P = 0.09, in the prosthetic group). Conclusions: For elderly individuals belonging to the studied diagnostic groups, the goal of enhancing normal weight bearing on the afflicted limb during the time course of 2-3 wks might be unrealistic.