Two-Month Individually Supervised Exercise Therapy Improves Walking Speed, Step Length, and Temporal Gait Symmetry in Chronic Stroke Patients: A before-after Trial.

Kiyoshi Yoshioka,Kimikazu Honda,Norikazu Maruyama,Mizuki Yoshioka,Tatsunori Watanabe,Keita Iino,Koshiro Hayashida

doi:10.3390/healthcare10030527

Kiyoshi Yoshioka, Kimikazu Honda + Show 5 more

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https://doi.org/10.3390/healthcare10030527

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Abstract

Gait asymmetry is common after stroke and is a major risk factor for falls. In particular, temporal gait asymmetry often remains in the chronic stage of stroke. However, health insurance does not cover rehabilitation for patients with chronic stroke in many countries. Accordingly, it is undetermined whether individually supervised exercise therapy has beneficial effects on chronic hemiparetic gait. Patients with stroke (n = 25) more than 6 months after onset performed 70 min of individually supervised exercise twice weekly for 2 months in 16 sessions with qualified personnel. The intervention significantly reduced the pre-swing phase on the paretic side (mean = 91.8%, 95%CI, 84.8–98.8). In addition, there was a significant improvement in pre-swing phase symmetry in those with great asymmetry prior to the intervention (p = 0.022). Step length significantly increased after the intervention on both sides (non-paretic, p = 0.029; paretic, p = 0.0055). Walking time at both comfortable and maximum speeds was significantly shortened (comfortable, p = 0.0041; maximum, p < 0.0001). Our findings suggest that there remains scope to improve gait ability with individually supervised exercise therapy in patients with chronic stroke, whose functional recovery is often considered unlikely. This type of intervention may be a simple and effective option to improve gait parameters, including temporal asymmetry, even in patients with chronic stroke.

Highlights

Stroke is a leading cause of disability worldwide [1], and functional walking ability is an important outcome for patients following stroke
Hemiparetic gait patterns are typically characterized by spatiotemporal asymmetry [4,5], which is related to reduced walking efficiency [6] and is a significant risk factor for falls in patients following stroke [7,8]
As some previous studies have demonstrated, improvements in gait symmetry depend on the initial gait asymmetry level [25,26]; we divided the subjects into two subgroups depending on the pre-swing phase asymmetry level at baseline (>1.1-fold in the paretic/non-paretic pre-swing ratio, n = 15) [27]

Summary

Introduction

Stroke is a leading cause of disability worldwide [1], and functional walking ability is an important outcome for patients following stroke. Many patients continue to have residual gait deficits and have difficulty returning to community living and their life roles in the chronic post-stroke stage [2,3]. Hemiparetic gait patterns are typically characterized by spatiotemporal asymmetry [4,5], which is related to reduced walking efficiency [6] and is a significant risk factor for falls in patients following stroke [7,8]. Gait asymmetry is commonly targeted in post-stroke rehabilitation to facilitate the recovery of walking function [9,10]. Repeated rehabilitation using either a normal or split-belt treadmill improves walking speed and step length asymmetry in patients with chronic stroke [9,10]. Orthoses have long been used to improve walking ability in patients following stroke. Ankle-foot orthoses improve the asymmetry of stance time of the gait cycle [12] but not dynamic balance [13]

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