Effect of Gait Training on Functional Recovery in a Patient with Left Middle Cerebral Artery (MCA) Stroke: A Case Study

Abstract

Background: Stroke involving the left middle cerebral artery commonly produces right hemiparesis with impaired selective motor control, reduced balance reactions, asymmetrical weight bearing, slow walking, poor endurance, and difficulty in daily mobility. Gait training is a central component of neurophysiotherapy because walking ability determines independence in transfers, toileting, household ambulation, community participation, and return to family roles. A structured gait programme combines postural preparation, task-specific stepping, stance control, rhythmic practice, feedback, strength training, balance activities, and progressive functional walking tasks. This case study describes the effect of gait training on functional recovery in a patient with left MCA stroke.

Presentation of Case: A 57-year-old right-handed male presented to the physiotherapy department six weeks after a first-ever left MCA ischemic stroke. He had right-sided weakness, mild expressive speech difficulty, reduced confidence in standing, and dependence for indoor walking. He was medically stable, alert, cooperative, and able to follow simple verbal and visual instructions. The main complaints were dragging of the right foot, reduced stance time on the right lower limb, fear of falling, difficulty turning, inability to climb stairs independently, and fatigue after short walking distance.

Intervention: The patient received six weeks of supervised gait training, five sessions per week, with each session lasting approximately forty-five to sixty minutes. Treatment included trunk alignment, sit-to-stand practice, supported weight shifting, affected-limb loading, stepping drills, ankle dorsiflexor facilitation, knee control training, overground gait practice, treadmill walking with safety support, visual cueing, obstacle negotiation, stair practice, endurance walking, and a structured home programme. Progression was guided by quality of movement, safety, fatigue, balance response, walking speed, and functional carryover into daily activities.

Outcome Measures: Functional recovery was documented using the Fugl-Meyer Assessment for Lower Extremity, Berg Balance Scale, Functional Ambulation Category, Ten-Meter Walk Test, Timed Up and Go Test, Six-Minute Walk Test, Modified Ashworth Scale, and a therapist-maintained functional mobility log covering transfers, indoor walking, turning, stair activity, and household participation.

Results: At the end of six weeks, the patient demonstrated measurable improvement in lower limb motor control, standing balance, walking independence, gait speed, endurance, and confidence. The Fugl-Meyer Lower Extremity score increased from 18/34 to 27/34, the Berg Balance Scale score increased from 28/56 to 44/56, Functional Ambulation Category improved from 2 to 4, self-selected gait speed improved from 0.28 m/s to 0.64 m/s, Timed Up and Go reduced from 42 seconds to 24 seconds, and Six-Minute Walk distance increased from 82 m to 186 m. Qualitatively, right foot clearance, step length symmetry, turning control, and transfer independence improved.

Conclusion: The case findings indicate that structured, progressive, and task-oriented gait training can improve functional recovery after left MCA stroke. Combining preparatory postural control with repetitive walking practice helped the patient progress from assisted household ambulation to supervised independent indoor mobility with improved safety and participation.