Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke

Abstract

Background
The study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of individuals with stroke. CBWS involves a forced shift of body weight towards a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity.

Methods
Eleven patients with acute stroke were randomly assigned to experimental and control groups. The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg’s Balance, and Fugl-Meyer’s Scores were recorded before and after the intervention.

Results
Weight bearing on the affected side increased in the experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the groups (P < 0.05). However, experimental group (P = 0.01) demonstrated larger improvements in gait velocity compared to the control group (P = 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups.

Conclusion
The implementation of a two-week intervention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke. The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke.

Full text

International Scholarly Research Network
ISRN Rehabilitation
Volume 2012, Article ID 328018, 7 pages
doi:10.5402/2012/328018
Research Article
Compelled Body Weight Shift Technique to Facilitate
Rehabilitation of Individuals with Acute Stroke
Sambit Mohapatra,
1
Aileen C. Eviota,
2
Keir L. Ringquist,
2
Sri Ranjini Muthukrishnan,
3
and Alexander S. Aruin
1
1
Department of Physical Therapy, University of Illinois at Chicago, 1919 West Taylor Street (MC 898), Chicago, IL 60612, USA
2
Department of Physical Therapy, University of Illinois at Chicago Medical Center, Chicago, IL 60612, USA
3
Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
Correspondence should be addressed to Alexander S. Aruin, aaruin@uic.edu
Received 30 March 2012; Accepted 8 May 2012
Academic Editors: M. Dam and K. Masani
Copyright © 2012 Sambit Mohapatra et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Background. The study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of
individuals with stroke. CBWS involves a forced shift of body weight towards a person’s affected side by means of a shoe insert
that establishes a lift of the nonaffected lower extremity. Methods. Eleven patients with acute stroke were randomly assigned to
experimental and control groups. The experimental group received a two-week conventional physical therapy combined with
CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg’s Balance, and
Fugl-Meyer’s Scores were recorded before and after the intervention. Results. Weight bearing on the affected side increased in the
experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the
groups (P<0.05). However, experimental group (P
= 0.01) demonstrated larger improvements in gait velocity compared to the
control group (P
= 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups. Conclusion. The implementation of a
two-week inter vention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke.
The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation
program for individuals with acute stroke.
1. Introduction
Stroke is the leading cause of serious, long-term disability
among American adults. Each year in the United States
approximately 795,000 people sustain a new or recurrent
stroke [1] and nearly half survive with some level of
neurological impairment and disability [2]. It is a common
observation that individuals with stroke-related hemiparesis
exhibit asymmetry in quasistatic standing postures as well
as during functional movements [3–5]. The causes of asym-
metries include motor weakness [6], asymmetric muscular
tone [7, 8], and somatosensory deficits [6]. Stroke-related
asymmetries affect the performance of functional activities.
For example, it was reported that asymmetries of stance
contribute to balance impairments in individuals with stroke
seen as increased postural sway [8], disordered gait, and
increased probability of falls [9]. The degree of asymmetrical
weight bearing has b een correlated with a decrease in motor
function, decrease in the level of self-care independence, and
increase in the length of hospital stay after stroke [10]. It was
also suggested that weight-bearing asymmetry and impaired
balance function may be a consequence of learned disuse
of the paretic leg [11]. Indeed, it is known that following
a stroke, when significant paresis exists, an individual with
hemiparesis may be unable or reluctant to bear much weight
through the paretic limb. However, a continued weight-
bearing asymmetry fosters further disuse of the affected side
despite the probability that improved motor function in the
lower limb has occurred. Such a learned disuse of the affected
limb may contribute to the lack of progress in recovery of
some individuals with stroke.
Several treatment approaches are used to improve
weight-bearing symmetry in individuals with stroke. Among
them are rehabilitation interventions that involve voluntary

2 ISRN Rehabilitation
Table 1: Descriptive characteristics of study participants (n = 11).
Subject no.
Height
(m)
Weight
(kg)
Age, years Gender
Ischemic
(I)/Hemorrhag
(H)
Location of stroke
Time since
stroke
(days)
FIM
ambulation
score at start
of treatment
Experimental group
(1) 1.8 83.5 42 Male I Right temporo parietal 12 1
(2) 1.6 70.3 59 Female H Left thalamic 10 1
(3) 1.8 102.5 33 Male I Right parieto-occipital 13 2
(4) 1.6 54.9 49 Male H Left frontoparietal 8 2
(5) 1.6 81.6 36 Female I
Right middle cerebral
artery (MCA)
13 4
Mean ± SE 1.68 ± 0.05 78.56 ± 7.943.8 ± 4.711± 0.92± 0.5
Control group
(6) 1.9 94.8 41 Male H
Left posterior temporal
and parieto-occipital
74
(7) 1.8 74.4 52 Male I Right MCA occlusion 9 2
(8) 1.5 52.6 62 Female H
Left intraparenchymal
and subarachnoid
21 2
(9) 1.5 72.6 73 Female H Left thalamic 11 2
(10) 1.7 83.9 40 Male H
Right basal ganglia and
temporal
45 2
(11) 1.6 59 54 Male I Right embolic 13 1
Mean ± SE 1.66 ± 0.07 72.88 ± 6.353.7 ± 5.118± 62.2 ± 0.4
FIM: Functional Independence Measure. The difference between the groups was not statistically significant: height (P = 0.88), weight (P = 0.58), age
(P
= 0.19), time since the stroke (P = 0.34), and FIM (P = 0.68).
shifts of body weigh t based on dynamic visual [12, 13]or
auditory feedback [14] about relative weight distribution
over the paretic and nonparetic limb, or weight shifting
exercises [15]. A single session of using shoe wedges and shoe
lifts on the nonaffected side have been shown to improve
the symmetry of weight bearing in patients with chronic
stroke by compelling them to shift the body weight to the
paretic leg [4]. It was also demonst rated that a 10 mm
shoe lift is appropriate to induce sufficient symmetry in
weight bearing. Such a shoe lift, when coupled with a
six-week goal-directed balance exercise, showed significant
improvement of walking sp eed, stride length, and symmetry
of weight bearing in a patient with chronic stroke [11].
However, it is not known whether or not individuals with a
recent stroke would improve the symmetry of weight bearing
while using a shoe lift on the unaffected side. As such, the
overall objective of this research was to test the efficacy
of a new form of rehabilitation namely, Compelled Body
Weight Shift (CBWS) therapy. This rehabilitation therapy
involves a forced shift of body weight towards the affected
lower extremity by means of a shoe insert that establishes
a prolonged lift of the nonaffected lower extremity. The
underlying mechanisms of the Compelled Body Weight Shift
is that the forced shift of body weight towards the affected
lower extremity helps in overcoming the learned disuse of
the paretic leg.
We hypothesized that using a shoe lift on the unaffected
side combined with conventional physical therapy treatment
would improve stance and weight-bearing symmetry in
patients with acute stroke. We also hypothesized that patients
provided with CBWS therapy, who used a shoe lift on the
nonaffected side, would demonstrate greater improvements
in gait velocity compared to the patients who were treated
with conventional therapy alone.
2. Methods
2.1. Subjects. The study participants were recruited from
the cohort of stroke patients admitted to the University of
Illinois at Chicago Medical Center Rehabilitation Unit. The
inclusion criteria for the study were a single, acute (less than
20 days), unilateral stroke with asymmetry of weight bearing
(weight bearing on the affected side of less than 35% of the
total body weight [4, 16]), ability to stand and maintain
balance with minimal assist (FIM ambulation score of at
least 1), and ability to understand and follow instructions.
The exclusion criteria were serious or unstable m edical con-
ditions, history of other neurological diseases (i.e., chronic
stroke, Parkinson’s disease, and multiple sclerosis), other
comorbidities, and fixed contractures or deformity. Eleven
individuals who satisfied the inclusion/exclusion criteria
were selected. Their mean age was 49.2
± 3.7 years and the
mean time since the stroke accident was 14.7
±3.2 days. There
were four females and seven males (Table 1). Al l subjects
were ambulatory with assistive devices and had no history of
previous st rokes. The difference between the groups was not
statistically significant: height (P
= 0.88), weight (P = 0.58),

ISRN Rehabilitation 3
CBWS
33% 67% 50% 50%
Weight bearing
Figure 1: Schematic representation of a stroke-related asymmetry of stance and weight-bearing (left) and how a shoe insert restores weight-
bearing symmetry by lifting the nonaffected lower extremity (right).
age (P = 0.19), time since the stroke (P = 0.34), and FIM
score (P
= 0.68). The subjects were randomly assigned to two
groups: experimental and control. The study protocol was
approved by the University of Illinois at Chicago Institutional
Review Board. Prior to the experiment, all participants
signed a written consent with the objectives and methods of
the study clearly explained. The subjects who qualified for
the study were selected and recruited over one-year per iod.
2.2. Intervention. To achieve the compelled body weight
shift, the individuals with hemiparesis included in the
experimental group were provided with shoe lifts of 0.6 cm
fabricated from medium hardness foam material made of
ethylene vinyl acetate, while no shoe lift was provided to
those included in the control group. Thus, each subject
included in the experimental group wore shoes with the
installed shoe lift (innersole) on the unaffected limb during
the time of treatment (Figure 1). The subjects in both groups
received similar physical therapy treatments, six times a week
for two consecutive weeks. The duration of each treatment
session was at least 90 minutes on weekdays and 30 minutes
on Saturdays. Physical therapy interventions included (a)
therapeutic exercises involv ing active and active-assisted
range of motion tra ining, (b) resistive exercises with Thera-
Band and/or weights, (c) motor retraining activities such as
static and dynamic standing and gait a ctions, (d) gait training
involving walking over ground, on a treadmill, body weight
support treadmill training, walking on indoor/outdoor sur-
faces, and stair training, and (f) functional performance
training such as sit to stand maneuvers at varied heights and
bed mobility exercises.
2.3. Outcome Measures. All participants underwent a battery
of identical tests two times, before the start of the rehabilita-
tion intervention (before test) and following its completion
(after test).
Weight bearing was measured with a digital weig hing
scale (Scale-Tronix, 5005 Stand-On Scale). During the assess-
ment, the subject stood in such a way that his/her affected
leg was on the platform of the scale while the unaffected leg
was on a wide wooden block (with the length 0.51 m, height
0.06 m, and width 0.29 m, which matched the dimensions
of the weighing scale platform) adjacent to the platform of
the scale. Then, the subject was positioned on the platform
of the scale and the entire body weight was recorded. The
measurements were repeated three times. Weight bearing
on the affected side for each subject was calculated as a
percentage of the entire body weight.
Gait velocity was obtained when the subject walked
normally with a cane at his/her comfortable walking speed
across a 10 m walkway. The time of crossing 5 m along this
walkway was recorded with a stopwatch. No lift insert was
used during any tests.
Balance performance was determined by the Berg Bal-
ance Scale (BBS). The BBS, a 14-item scale designed to
measure balance in a clinical setting with a maximum score
of 56 [17]. Each item is scored from 0 (cannot perform
the task) to 4 (the best performance), including the ability
to maintain sitting balance, static and dynamic standing
balance, and stability during functional transfer tasks. In this
scale, a score of 0–20 indicates that the subject is wheel-
chair bound, a score of 21–40 suggests the individual needs
assistance while walking, and a score of 41–56 means the
individual is independent [18]. This test has been shown

4 ISRN Rehabilitation
to be correlated with other tests of mobility and balance,
including the Tinetti mobility index and the Get Up and
Go tests [17], and it is considered to be a valid and reliable
clinical tool [19].
The Fugl-Meyer Assessment (FMA) [20] for the lower
extremities was administered for the following five domains
(total score
= 100): motor function (maximum score =
34), sensation (maximum = 12), sitting/standing balance
(maximum
= 14), joint range (maximum = 20), and joint
pain (maximum
= 20). This test has been shown to be valid
and reliable for assessing the recovery of function [21], is
correlated w ith the capacity to perform ADL activities [20],
and is commonly used for measuring motor recovery after
stroke [22].
2.4. Data Analysis. Descriptive analysis was used to analyze
the demographic data in each subject group. Split plot
ANOVAs were performed with time (before test and after
test) as the within-subjects factor for the various dependent
variables (weight bearing , g ait velocity, BBS, and FMA)
whereas group (experimental or control) was the between-
subjects factor. SPSS 17 software for Windows 7 was used
for data a nalysis (SPSS Inc., Chicago, IL, USA). For all tests,
statistical significance was set at P<0.05.
3. Results
Figure 2 shows the mean group data for weig ht bear ing
obtained before the start of intervention and after the
end of the intervention. All of the subjects demonstrated
asymmetrical weight bearing at the time of the first test:
weight bearing of the individuals included in the exper-
imental group was 32.4
± 0.06 and it was 30.2 ± 0.04
percent of the body weight in the control group. The
difference between the experimental and control subjects was
not statistically significant (P
= 0.89). The mean weight
bearing increased after test reaching 37.9
± 0.05 percent in
the experimental group of subjects approaching the level
of statistical significance (P
= 0.07). The mean weight
bearing on the affected side of the subjects in the control
group decreased after test to 27.4
± 0.06; however, such a
decrease was not statistically significant (P
= 0.29). The
difference between the groups was not statistically significant
(P
= 0.44).
Figure 3 shows the mean group data for gait velocity.
Before the start of treatment, individuals included in the
experimental group and those included in the control group
demonstrated similar gait velocities of 0.17
± 0.02 and 0.17 ±
0.04 m/s, respectively (P = 0.66). After intervention, gait
velocity increased in both groups reaching 0.55
± 0.2m/sin
the experimental and 0.28
± 0.1 m/s in the control groups.
While the increase in gait velocity with treatment was
significant in both the experimental (P
= 0.01) and control
(P
= 0.002) g roups, the experimental group showed greater
improvements in g a it velocity than the controls, although the
difference was not statistically significant (P
= 0.51).
Before the start of treatment, the BBS of the individuals
included in the experimental group was 19.2
± 3.1 and it
60
45
30
15
0
Weight bearing (%)
Experimental Control
Before
After
Figure 2: Changes in the percentage of weight bearing on the
affected side (% of the total body weight). Mean
± SE are shown.
0.8
0.6
0.4
0.2
0
Gait velocity (m/s)
Experimental Control
∗
∗
Before
After
Figure 3: Changes in gait velocity (in m/s) with treatment. Mean ±
SE are shown.
∗
shows statistical significance at P<0.05.
was 13.2 ± 3.06 in the control group: the scores were not
significantly different between the groups (P
= 0.57). After
completion of the two-week intervention, BBS improved
reaching 41.2
± 1.9 in the experimental group and 36.7 ± 2.4
in the control group. ANOVA revealed the effect of treatment
for the experimental (P
= 0.003) and control groups (P =
0.001). However, the difference between the groups was not
statistically significant (P
= 0.46).
Before the start of the intervention, the total FMA score
(lower extremities) for the experimental group was 77
± 1.7

ISRN Rehabilitation 5
and the control group had a score of 73.3
± 3.5. This
difference in FMA scores between the experimental and the
control groups was not statistically significant (P
= 0.66).
After test, FMA scores improved for both groups reaching
89
± 0.9 for the experimental and 86 ± 4.0 for the control
groups (P
= 0.67). The results of ANOVA (P = 0.003)
and (P
= 0.001) for the experimental and control groups,
respectively, confirmed the main effect of the time.
4. Discussion
There is a consensus among clinicians regarding the impor-
tance of retraining the ability of individuals suffering from
stroke to maintain symmetrical stance [12]. Accordingly,
there is a need to develop simple and efficient rehabilitation
approaches to restore symmetrical stance after stroke. One
such novel approach, CBWS therapy, was evaluated i n the
current study. The main finding was the improvement of
symmetry of weight bearing with intervention involving
a CBWS, the compelled shift of body weight towards the
subject’s affected side. The study outcome supports the first
hypothesis that implementing a shoe lift on the unaffected
side during conventional physical therapy improves sym-
metry of stance and weight bearing of the paretic lower
extremity. The second hypothesis was also supported as the
patients provided with the shoe lift demonstrated larger
improvements in gait velocity compared to the patients who
were treated using only conventional therapy.
4.1. Role of CBWS in the Improvement of Symmetry of Weight
Bearing. The results of the cur rent study demonstrated that
individuals with acute stroke improve the symmetry of
weight bearing while participating in conventional physical
therapy combined with CBWS therapy. Why were the
patients who were provided with a shoe lift able to learn
to transfer more weight to the paretic leg than the control
group who was not given the lift? One possible explanation
is that a simple shoe lift would compel the patient to
shift more weight to the affected side. Such a compelled
redistribution of body weight resembles the concept of “force
use” of the affected extremity as promoted by Taub et al.
[23]. The improvement of weight-bearing symmetry while
using a shoe lift most likely helped those individuals avoid
the development of learned disuse of the affected limb. It
is important to note that individuals in the control group
did not show improvement in weight-bearing symmetry and
instead showed minor worsening after treatment. As such,
the observed decline in weight-bearing symmetry suggests
that individuals in the control group could develop learned
disuse of the affected limb and asymmetrical stance and
would require additional treatment to eliminate such a
probability.
Previous studies suggest that the impaired ability to
shift weight onto the nonparetic leg is more pronounced in
patients with right-cortical damage [24]. As such, it is not
surprising that subjects in the exper imental group who had
left side damage showed 8.7
± 3.9 percent improvement of
weight bearing on the affected side, whereas patients with
right hemispheric lesions showed only 0.89
± 0.5percent
improvement in weight bearing. Such differences in the
achievement of more symmetrical weight bearing between
the patients with right and left hemispheric lesions suggests
for a need to tailor the CBWS protocol to treatment of
individuals with right hemispheric lesions as they might need
more time to improve weight-bearing symmetry compared
to the patients with left hemispheric lesions. This study
outcome however, could be considered only as preliminary
because the difference in the percentage of the weight bearing
improvement was not statistically significant due to the small
subgroup sizes.
It was shown previously that individuals with chronic
stroke provided with a shoe lift show improvements in
symmetry of quite stance [4, 11]. Similarly, individuals
postacute stroke, trained with the feedback device (that
provided dynamic visual information about relative weight
distribution over the paretic and nonparetic limb) showed
significantly better static standing symmetry than subjects
who did not receive augmented feedback [13]. It was also
reported that a training program that was based on weight
transfer and balance exercises performed under different
conditions of manipulation of sensory inputs resulted in a
significant improvement in the ability to maintain balance
control in patients with chronic stroke [25]. Further more,
an increase in weight bearing on the paretic leg (from 41–
42 percent to 65–68 percent) has been reported in post-acute
patients with hemiparesis when they placed their nonparetic
foot on a step, regardless of step height (10 cm or 17 cm)
[26]. It is important to note that the literature data suggests
that individuals following stroke are able to bear more than
50 percent of their body weight through the affected lower
extremity [16]. As such, the difficulties in restoring the
symmetry of weight bearing that many individuals with
stroke experience are due to a learned disuse of the affected
leg r ather than the impaired ability of the affected leg to bear
the weight of the body.
4.2. Role of CBWS in Improvement of Gait Velocity. The lim-
ited walking ability that follows a stroke significantly limits
the patients’ capability to participate in many community
activities. Moreover, gait velocity has been reported to be
a predictor of the severity of impairment [27] and the
restoration of the ability to walk is considered to be the major
goal of stroke rehabilitation [28]. Most common methods
used to restore gait in individuals suffering from a stroke
include functional electrical stimulation (FES) [29], body
weight-supported treadmill training (BWSTT) [28], and
robotic-assisted gaitretr aining [30]. While the importance
of the above-mentioned approaches is acknowledged, other
methods are used which do not require expensive equipment
and which can be implemented in any clinical facility.
Such methods include overground walking combined with a
traditional funct ional strengthening exercise and practicing
single movements or various neurofacilitation techniques
[28]. Moreover, it was reported in the literature that over-
ground walking enhances locomotor recovery more than
other forms of therapy [31].

6 ISRN Rehabilitation
The outcome of the current study demonstrated that gait
velocity is improved when individuals with stroke use a shoe
lift on the nonaffected side during treatment. It is important
to note that the improvement of gait velocity was achieved in
parallel w ith the improvement in weight-bearing symmetry.
This result is in contrast with the previously published data
on the lack of observed improvement of walking function
after the use of a feedback device that provided visual infor-
mation about relative weight distribution over the paretic
and nonparetic limb [13]. The improvement in gait velocity
in our study could be associated with the fact that weight-
bearing symmetry was achieved by providing a shoe lift
during the entire time of treatment that involved ambulation.
Such a combination of interventions (overground gait a nd
a compelled shift of the body weight) had a positive effect
on the ability of a patient to overcome (or to prevent the
development of) a learned disuse of the affected leg.
It is also important to note that while both groups of
subjects increased the velocity of their gait with treatment,
individuals in the experimental group showed a 30 percent
increase in the velocity of their gait while the control subjects
demonstrated only a 6 percent increase in gait velocity.
Thus, using the CBWS as an addition to conventional
physical therapy resulted in the ability of the patients in the
experimental group to achieve gait velocity that is considered
at the level of limited community ambulation whereas in the
control group the gait velocity increased only to the level of
ambulation within the household [32].
4.3. Role of CBWS in Improvement of Clinical Measures . The
restoration of balance and the enhancement of motor recov-
ery continue to be major rehabilitation goals for persons
with stroke. Both groups showed improvement in their BBS
and FMA after treatment. However, the individuals in the
experimental group showed larger improvements in both the
BBS and FMA compared to the control group. Thus, the BBS
increased in individuals receiving CBWS by 22 points (46
percent) while in the control group it increased by 23.5 points
(35 percent). It was also demonstrated that a difference
of five to seven BBS points is necessary to conclude with
90 percent certainty that patients receiving rehabilitation
following stroke have undergone a real change in BBS when
assessed in a between-rater situation [33]. Thus, we can
conclude that a 46 percent increase in BBS is certainly a
manifestation of the effect of the CBWS approach. Moreover,
individuals in the experimental group demonstrated BBS
that are closer to that proposed in the literature which was
a 45–58 point cut-off value for predicting a high risk for
falls associated with clinically impaired balance and transfer
ability in healthy elderly subjects [34]. However, this increase
in BBS in the experimental group should be considered with
caution because the groups had slightly different initial scores
(although not statistically significant), which most likely
masked the effect of using the shoe lift in the improvement
of BBS.
The FMA score for lower extremity has been a moderate
predictor of both improvements in gait velocity and stride
length in patients with stroke [35, 36]. In our study, the FMA
scores in the experimental group increased by 12 points while
the subjects in the control group increased the scores by 12.7.
Relatively similar FMA gains in both of the groups could be
explained by the short duration of the intervention because
it is expected that motor recovery continues after the initial
two-week period. As such, future studies are needed to assess
the effect of CBWS therapy on motor recovery.
There are several limitations that should be considered.
First, the findings of this study could only be applied to the
relatively young, acute patients who are able to walk without
physical assistance for 10 m. The effectiveness of CBWS on
patients with higher levels of impairment is not clear. Second,
many of the contacted patients who expressed an interest
were unable to walk without physical assistance as such the
number of participating subjects was relatively small. Third,
the effect of different parameters of CBWS such as duration
of treatment and its intensity, height of the lift, and so forth
were not examined in the present study. Fourth, the long-
term effec t of CWBS was not examined in this research. As
such, a larger study is needed to investigate the effect of
CBWS on acute stroke patients with different mobility levels,
the parameters and intensity of CBWS, and the carry-over
effects of CBWS.
5. Conclusions
A two-week intervention involving compelled body weight
shift therapy induced by a shoe lift on the unaffected side
led to an improvement in the symmetry of weight bearing
and gait velocity in individuals w ith acute stroke. Thus, a new
technique helps to facilitate rehabilitation of individuals with
acute stroke.
Acknowledgments
This work was supported by NIH grant HD-50457. The
authors thank the individuals with stroke for their excep-
tional cooperation.
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