櫻井 宏明

Objective: To identify factors associated with earlier independence in “real-life walking” during hospitalization in subacute stroke patients.Design: Retrospective cohort study.Subjects/Patients: Two hundred and six hemiplegic patients.Methods: Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent “real-life walking” (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan–Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.Results: The median time to independence was 4 weeks, with significant differences (p < 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21–3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52–3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22–3.21) significantly affected earlier walking independence (all p < 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13–0.40; p < 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06–0.62; p < 0.01).Conclusion: Early improvement in “real-life walking” was associated with younger age, greater cognitive function, and greater “test-setting walking” ability on admission. Low activities of daily living independence and “test-setting walking” ability hindered early progress.

BackgroundThere is increasing recognition of the effectiveness of body weight-supported (BWS) walkers for stroke patients with hemiplegia. However, it is unclear whether the effectiveness of BWS walkers is because of the walker alone or the combined effect of the walker and body weight support.ObjectiveWe aimed to determine whether there are differences between normal, walker, and BWS walker gaits in patients after cerebral infarction (CI) and intracerebral hemorrhage (ICH).MethodsTwenty-one stroke patients with hemiplegia underwent trials under three gait conditions: normal, walker, and BWS walker gait. Spatiotemporal parameters and joint kinematics during walking were calculated using a three-dimensional motion analyzer. We further examined differences in effects depending on CI and ICH.ResultsSpeed and cadence improved in the walker gait and BWS gait groups compared with the normal gait group. In addition, the percentage of the stance and swing phases was improved in BWS walker gait compared to normal gait. Both patients with CI and those with ICH showed similar trends in gait parameters by BWS Walker.ConclusionsThese results suggest that using a BWS walker improves walking in stroke patients with hemiplegia in terms of gait parameter, and is a useful tool for gait training.