Goto Keisuke, Kawasaki Tsubasa, Hamada Hiroyuki, Sihan Lim Vivian, Shimada Ryusuke, Nakazato Rumiko, Horimoto Yukari, Ikeda Yumi
Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita City, JPN.
Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, JPN.
Cureus. 2025 Jun 18;17(6):e86264. doi: 10.7759/cureus.86264. eCollection 2025 Jun.
Background It is known that neurocognitive rehabilitation (NCR) improves post-stroke functional outcomes. However, systematic evaluations of changes in stride regularity and step regularity remain limited. Furthermore, a few studies have combined quantitative gait metrics with qualitative analyses of self-reported motor strategies, particularly in individuals with subacute stroke. Objective To examine immediate changes in key gait metrics - specifically vertical stride regularity and walking speed - as well as self-reported motor strategies following a single-session NCR intervention targeting hip and trunk proprioception in individuals with subacute stroke using a retrospective observational design. Methods Using a convergent mixed-methods design within a retrospective framework, we concurrently analyzed quantitative gait and qualitative interview data, which were subsequently integrated during the interpretation phase. Clinical data from 39 patients with subacute stroke were analyzed. Each participant underwent a single-session NCR intervention. Clinical records included trunk accelerometry-based gait assessments and self-reported motor strategies collected through semi-structured interviews. Quantitative gait data were analyzed as time series, and qualitative interview data were processed using text mining techniques. The findings were integrated via correspondence analysis, with patients categorized based on the percentage change in vertical stride regularity from baseline to immediately post-intervention. Results Statistically significant immediate changes in stride regularity (vertical and anteroposterior axes) and step regularity (vertical, mediolateral, and anteroposterior axes) were observed from pre- to post-intervention (T0 to T1), with medium to large effect sizes. Gait speed showed a statistically significant increase post-intervention to the following day (T1 to T2). Co-occurrence network analysis of interview data revealed a shift in reported motor strategies post-intervention, from distal segments (such as "feet" and "toes") to proximal segments (such as "hip joint," "waist," and "trunk"). The correspondence analysis suggested that patients with greater changes in vertical stride regularity described strategies emphasizing proximal control, whereas those with smaller changes referenced distal segments or fall prevention-oriented strategies. Conclusions A single session of NCR focusing on hip and trunk proprioception was associated with immediate changes in gait regularity and symmetry, as well as patients' awareness of their motor strategies in subacute stroke. The integration of objective and subjective assessments may support more personalized rehabilitation planning. Prospective studies are warranted to further investigate these findings.
背景 已知神经认知康复（NCR）可改善中风后的功能结局。然而，对步幅规律性和步频规律性变化的系统评估仍然有限。此外，少数研究将定量步态指标与自我报告的运动策略定性分析相结合，尤其是在亚急性中风患者中。目的 采用回顾性观察设计，研究针对亚急性中风患者髋部和躯干本体感觉的单次NCR干预后关键步态指标（特别是垂直步幅规律性和步行速度）以及自我报告的运动策略的即时变化。方法 在回顾性框架内采用收敛性混合方法设计，我们同时分析定量步态和定性访谈数据，随后在解释阶段将其整合。分析了39例亚急性中风患者的临床数据。每位参与者都接受了单次NCR干预。临床记录包括基于躯干加速度计的步态评估和通过半结构化访谈收集的自我报告的运动策略。定量步态数据作为时间序列进行分析，定性访谈数据使用文本挖掘技术进行处理。通过对应分析整合研究结果，根据从基线到干预后即刻垂直步幅规律性的百分比变化对患者进行分类。结果 干预前至干预后（T0至T1）观察到步幅规律性（垂直和前后轴）和步频规律性（垂直、内外侧和前后轴）有统计学意义的即时变化，效应量为中到大。干预后至次日（T1至T2）步态速度有统计学意义的增加。访谈数据的共现网络分析显示干预后报告的运动策略发生了转变，从远端节段（如“脚”和“脚趾”）转向近端节段（如“髋关节”、“腰部”和“躯干”）。对应分析表明，垂直步幅规律性变化较大的患者描述的策略强调近端控制，而变化较小的患者则提及远端节段或预防跌倒的策略。结论 在亚急性中风中，单次聚焦于髋部和躯干本体感觉的NCR与步态规律性和对称性的即时变化以及患者对其运动策略的认知有关。客观和主观评估的整合可能有助于制定更个性化的康复计划。有必要进行前瞻性研究以进一步探究这些发现。
