Determinants of Step-through Gait Pattern Acquisition in Subacute Stroke Patients

• Published in: Progress in Rehabilitation Medicine Vol. 7; p. 20220035
• Main Authors: Inoue, Seigo, Mori, Naoki, Tsujikawa, Masahiro, Ishii, Ryota, Suzuki, Kanjiro, Kondo, Kunitsugu, Kawakami, Michiyuki
• Format: Journal Article
• Language: English
• Published: The Japanese Association of Rehabilitation Medicine 01.01.2022; JARM
• Subjects: knee joint extension; Original; paralyzed; recovery; rehabilitation; strategy
• ISSN: 2432-1354; 2432-1354
• DOI: 10.2490/prm.20220035

Objectives: Stroke patients may have a step-to gait pattern during the early stages of gait reacquisition. This gait provides stability, but it is slow and inefficient. Therefore, acquiring step-through gait is desirable for better efficiency as ability improves. This study aimed to examine the relevant factors affecting the acquisition of step-through gait pattern in subacute stroke patients based on assessments of physical function at admission.Methods: This was a retrospective cohort study. A total of 91 patients with hemiplegic stroke, Functional Independence Measure (FIM) gait item of 4 or less on admission, and FIM gait item of 5 or greater on discharge were included. Factors necessary for the acquisition of step-through gait pattern were examined based on the motor function assessed by Stroke Impairment Assessment Set (SIAS) at the time of admission. Gait pattern was defined by the gait step length of the Tinetti Performance-Oriented Mobility Assessment at discharge.Results: Knee-joint extension function on the paralyzed side was determined as a factor associated with the acquisition of step-through gait pattern at discharge [odds ratio 2.24, 95% confidence interval (CI) 1.44‒3.50, P<0.001]. The area under the receiver operating characteristic curve for predicting the step-through gait pattern at discharge was 0.786 (95% CI 0.676–0.896, P<0.001) for the SIAS knee joint score at admission; the optimal cut-off score being 2 or greater (sensitivity 81%, specificity 61%).Conclusions: Knee function on the paralyzed side in subacute stroke patients is an independent predictor for the acquisition of step-through gait pattern.