Mizuta Naomichi, Hasui Naruhito, Higa Yasutaka, Matsunaga Ayaka, Ohnishi Sora, Sato Yuki, Nakatani Tomoki, Taguchi Junji, Morioka Shu
Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-Cho, Handa, Aichi, 475-0012, Japan.
Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-gun, Koryo, Nara, 635-0832, Japan.
Sci Rep. 2025 Jan 21;15(1):2704. doi: 10.1038/s41598-025-86167-9.
In post-stroke persons, temporal gait asymmetry (TGA) during comfortable gait involves a combination of pure impairments and compensatory strategies. In this study, we aimed to differentiate between pure impairments and compensatory strategies underlying TGA in post-stroke individuals and identify associated clinical factors. We examined 39 post-stroke individuals who participated in comfortable walking speed (CWS) and rhythmic auditory cueing (RAC). Gait evaluation included spatiotemporal parameters and trunk acceleration, while clinical evaluation comprised motor paralysis severity, sensory disturbances, spasticity, balance ability, and gait efficacy. The participants were classified by clustering based on the symmetry index during CWS and RAC. TGA during CWS or RAC gait showed no association (ρ = 0.062, p = 0.707). Clustering yielded four optimal clusters. Cluster 1 was asymmetric during CWS but symmetric during RAC condition (over-compensatory strategies); these participants had a poor score on the modified gait efficacy scale, and despite mild functional impairments, they lacked the confidence to walk safely. Cluster 2 showed impairment-driven asymmetry during CWS and RAC, with severe impairments and instability. Participants showing improved TGA under auditory cueing compared with comfortable speed demonstrate strong compensatory strategies associated with low gait efficacy. This suggests a need for targeted interventions to enhance gait self-efficacy and maximize residual function.
在中风后患者中，舒适步态期间的颞侧步态不对称（TGA）涉及单纯损伤和代偿策略的组合。在本研究中，我们旨在区分中风后个体中TGA背后的单纯损伤和代偿策略，并确定相关的临床因素。我们检查了39名参与舒适步行速度（CWS）和节奏性听觉提示（RAC）的中风后个体。步态评估包括时空参数和躯干加速度，而临床评估包括运动麻痹严重程度、感觉障碍、痉挛、平衡能力和步态效能。根据CWS和RAC期间的对称指数通过聚类对参与者进行分类。CWS或RAC步态期间的TGA无相关性（ρ = 0.062，p = 0.707）。聚类产生了四个最佳聚类。聚类1在CWS期间不对称，但在RAC条件下对称（过度代偿策略）；这些参与者在改良步态效能量表上得分较低，尽管功能损伤较轻，但他们缺乏安全行走的信心。聚类2在CWS和RAC期间表现出损伤驱动的不对称，伴有严重损伤和不稳定。与舒适速度相比，在听觉提示下TGA改善的参与者表现出与低步态效能相关的强烈代偿策略。这表明需要有针对性的干预措施来提高步态自我效能并最大化残余功能。
