Sawa Kota, Tamura Miko, Arai Saori
Department of Physical Therapy, Faculty of Health Sciences, SBC Tokyo Medical University, Urayasu, Chiba, Japan.
Department of Rehabilitation, Tamus Sakura Hospital Edogawa, Edogawa-ku, Tokyo, Japan.
Brain Behav. 2025 Jun;15(6):e70535. doi: 10.1002/brb3.70535.
Orthotic therapy is crucial for post-stroke patients with severe motor paralysis and higher brain dysfunction, including pushers and unilateral spatial neglect (USN). These patients exhibit impaired postural control and compromised independence in activities of daily living (ADLs), often necessitating mid- to long-term intervention using knee-ankle-foot orthoses (KAFOs). However, the influences of extended orthotic intervention in severe and pusher cases remain unclear. The purpose of this study was to examine the influences of KAFO on walking ability and independence in severe hemiplegia with pusher and USN and pusher cases who wore KAFO and performed training routinely for more than 3 months.
This longitudinal, retrospective, and historical controlled study included 44 patients: 22 hemiplegics (hemiplegia group) and 22 pushers (pusher group). Demographic data were matched using a propensity score to adjust for heterogeneity, resulting in a 1:1 patient ratio. KAFOs in both groups were defined as those used within 1 week of the rehabilitation prescription date. This mean as motor paralysis was severe, patients who used KAFOs for at least 3 months in rehabilitation situations. Outcomes comprised the following: procedure A, comparing ambulation at admission and discharge (functional ambulation category [FAC]) and gait independence (FIM-gait) between groups;and procedure B, investigating factors affecting gait ability, and determinants of pusher behavior with USN presence, derived from demographics. In statistical analyses, procedure A employed two-way analysis of variance with Bonferroni post-hoc tests (p<0.05), whereas procedure B employed multiple regression analysis (Stepwise method) to examine gait independence within the two groups, and logistic regression analysis (Wald method) was used to examine factors that generate pusher behavior with USN.
In using orthotic devices, a significant interaction between gait independence and FAC, along with a simple main effect of timing and group, indicated less improvement at discharge for the pusher group (p < 0.05). Onset days and SPV variability errors influenced severe hemiplegia cases, whereas SPV-EO variability errors impacted USN cases, with moderate regression coefficients (p < 0.05).
Long-term KAFO intervention demonstrated improvement in severe hemiplegia and modest improvement in USN cases. The days since onset and SPV variability errors were crucial factors influencing gait independence in severe hemiplegia, whereas SPV-EO variability errors influenced a role in determining gait independence in patients with USN. This hindered gait independence in patients with pusher pain and USN, despite observed improvements in gait ability over time during the recovery process.
矫形治疗对于患有严重运动麻痹和高级脑功能障碍的中风后患者至关重要，这些患者包括推搡者和单侧空间忽视（USN）患者。这些患者表现出姿势控制受损以及日常生活活动（ADL）中的独立性受损，通常需要使用膝踝足矫形器（KAFO）进行中长期干预。然而，在严重和推搡者病例中延长矫形干预的影响仍不清楚。本研究的目的是探讨KAFO对伴有推搡和USN的严重偏瘫患者以及佩戴KAFO并常规训练超过3个月的推搡者病例的步行能力和独立性的影响。
这项纵向、回顾性和历史对照研究包括44名患者：22名偏瘫患者（偏瘫组）和22名推搡者（推搡组）。使用倾向评分匹配人口统计学数据以调整异质性，从而使患者比例为1:1。两组中的KAFO定义为在康复处方日期后1周内使用的矫形器。这意味着由于运动麻痹严重，患者在康复情况下使用KAFO至少3个月。结果包括以下方面：程序A，比较两组入院时和出院时的步行情况（功能步行分类[FAC]）和步态独立性（FIM-步态）；程序B，研究影响步态能力的因素以及存在USN时推搡行为的决定因素，这些因素来自人口统计学数据。在统计分析中，程序A采用双向方差分析和Bonferroni事后检验（p<0.05），而程序B采用多元回归分析（逐步法）来检查两组内的步态独立性，并且使用逻辑回归分析（Wald法）来检查产生伴有USN的推搡行为的因素。
在使用矫形装置方面，步态独立性和FAC之间存在显著交互作用，以及时间和组别的简单主效应，表明推搡组出院时改善较少（p<0.05）。发病天数和SPV变异性误差影响严重偏瘫病例，而SPV-EO变异性误差影响USN病例，回归系数适中（p<0.05）。
长期KAFO干预显示严重偏瘫患者有所改善，USN病例有适度改善。发病后的天数和SPV变异性误差是影响严重偏瘫患者步态独立性的关键因素，而SPV-EO变异性误差在确定USN患者的步态独立性中起作用。尽管在恢复过程中随着时间推移观察到步态能力有所改善，但这阻碍了伴有推搡疼痛和USN患者的步态独立性。
