Abe Hiroaki, Nishiyama Kazutaka, Yamamoto Yuichi, Okanuka Toru, Yonezawa Yasuhito, Matsumoto Koji
Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima 960-8516, Japan.
Department of Rehabilitation, Kita-Fukushima Medical Center, 23-1 Aza-higashi, Hakozaki, Date, Fukushima 960-0502, Japan.
Brain Sci. 2021 Oct 28;11(11):1430. doi: 10.3390/brainsci11111430.
Patients with severe hemiplegia along with knee instability require knee-ankle-foot orthoses (KAFOs) for gait training. However, in these patients, it is unclear which type of walking training is more effective to improve gait function. Providing alternate gait training (AGT) improves walking function in patients with spinal cord injury, but it is still unclear whether this is effective in hemiplegic stroke patients. In this study, we defined "unified AGT" as AGT performed with the same therapeutic concept by physiotherapists. We then investigated whether AGT improved gait function quicker than our traditional gait training in hemiplegic stroke patients. We enrolled 15 subjects with severe hemiplegia and knee instability who had undergone unified AGT using KAFOs with hinged oil dampers at the ankles, and 30 historical control (HC) subjects who had undergone traditional gait training. We used multiple comparison and survival analyses to analyze the differences in the functional independence measure (FIM) gait score changes between the two groups. The multiple comparison revealed a significant increase ( < 0.05) in the FIM gait score compared with its initial score in the subjects with unified AGT. However, this improvement was not seen in the HC subjects. Additionally, the survival analysis of time taken to recover revealed a significant difference between the subjects with unified AGT and HC subjects ( < 0.05). These findings suggest that unified AGT using a KAFO facilitates gait improvement in patients with severe hemiplegia and knee instability.
患有严重偏瘫且伴有膝关节不稳定的患者在进行步态训练时需要使用膝踝足矫形器（KAFO）。然而，对于这些患者，尚不清楚哪种类型的步行训练对改善步态功能更有效。提供交替步态训练（AGT）可改善脊髓损伤患者的步行功能，但在偏瘫性中风患者中其是否有效仍不明确。在本研究中，我们将“统一AGT”定义为由物理治疗师按照相同治疗理念进行的AGT。然后，我们调查了在偏瘫性中风患者中，AGT是否比传统步态训练能更快地改善步态功能。我们招募了15名患有严重偏瘫和膝关节不稳定且使用了在脚踝处带有铰链式油阻尼器的KAFO进行统一AGT的受试者，以及30名接受过传统步态训练的历史对照（HC）受试者。我们使用多重比较和生存分析来分析两组之间功能独立性测量（FIM）步态评分变化的差异。多重比较显示，与统一AGT受试者的初始评分相比，其FIM步态评分有显著提高（<0.05）。然而，HC受试者中未观察到这种改善。此外，对恢复所需时间的生存分析显示，统一AGT受试者与HC受试者之间存在显著差异（<0.05）。这些发现表明，使用KAFO的统一AGT有助于改善严重偏瘫和膝关节不稳定患者的步态。
