الفهرس 
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Abstract
Stroke is the most common cause of impaired motor function including gait and balance deficits, resulting in long term disability and handicap (Esteves et al., 2010). Walking recovery is a priority goal for most patients, since it widely determines the patient’s status with respect to activities of daily living and quality of life (Ayman et al., 2011). The gaiting of stroke patients is characterized by several abnormal features such as asymmetry of stride time and length, reduced velocity, poor joint and posture control, muscle weakness, abnormal muscle tone, abnormal muscle activation patterns and altered energy expenditure, mostly affecting the paretic side (Finch, Brooks and Stratford, 2006)). Purpose of the study The purpose of this study was to examine the effectiveness of using combined gait training and treadmill walking technique on selected clinical outcomes of patients with stroke. Setting and population A quasi experimental design was used. The study was conducted at Neurology and physiotherapy unit at shebin Elkom Menofia University Hospital, Menofia Governorate. A purposive sample of 5o adult patients, both sexes, aged from 19 to 65 years old was used. To achieve the purpose of the current study the following tools were used: a. Interviewing questionnaire. b. Barthel Index was modified by Shah et al., (1992) to measure independency in activity of daily living (ADL) for patient after stroke. c. Simplifed Stroke Rehabilitation Assessment of Movement (S- STREAM) Scale was modified by Hsueh et al., (2002) to measure voluntary movement and basic mobility. d. Berg Balance Scale was developed by Berg et al., (1999) to measure body balance. e. Oxford scale was developed by Smyth( 2009) to assess and record muscle power. f. Modified Ashworth scale was developed by Bohannon & Smith (1987) to measure muscle tone of patient with stroke. The study revealed the following findings: • The mean age of the participant was 55.12 (4.00) years old, belonging to the marital status; the majority of participants (68%) were married and 56% were illiterate. • The majority of the study samples (84%) had more than one symptom, belonged to the physical activity; the majority of the study samples (60 %) were able to care for themselves with assistance and 86 % suffered from hypertension. • The majority of the study samples (44%) had partial movement and 36%, belonged to the body balance; the majority of the study samples (56%) were able to walk with assistance whereas (80%) were dependent in activities of daily living before intervention. • There was a statistically significant improvement voluntary movement of sub-scale score of upper, lower limb and basic mobility post intervention. • There was a statistically significant improvement in the mean score of daily living activities at post intervention compared with pre intervention. • There was a statistically significant improvement in the mean score of body balance in post intervention than pre in intervention. • There was a statistically significant improvement in the mean score of muscle tone in post intervention than pre in intervention • There was a statistically significant improvement in the mean score of muscle strength in post intervention compared with pre intervention. Conclusion: Based on the findings of the current study, it can be concluded that the implementation of gait training program has led to improving patient function and motor performance regarding stroke rehabilitations. The combined gait training and treadmill walking has led to improvement in voluntary movement and basic mobility, activity of daily living, body balance ,muscle tone and muscle strength. Recommendation: Based on the findings of the study it was recommended that: 1– Nurses should be encouraged to implement the combined gait training and treadmill walking after three months of stroke to improve motor impairment and gait balance. 2– Replication of this study is recommended with several design changes such as, the use of randomized selection to achieve appropriate representation of population. 3– The study period should be extended more than three months. Extending the follow up period will provide more comprehensive information about the effect of combined gait training and treadmill walking on the improvement of all clinical outcomes score on longer period (as 6 months) because it is the expected time for significant improvement of all clinical outcomes (Michal, Nayak and Means, 2011). 4– Replication of this study in a larger scale to include clinical setting (multicenters). 5– Future studies also include large sample size while including a sufficient number is recommended.