[P3-0801] Effects of gait training in hemiparetic patients under restriction of non-paretic lower limb movement
Three single-case studies
キーワード：Gait training, Motor learning, Hemiplegic patients
【Purpose】It has been reported that stroke patients’gait and ADL improve through intensive training of their paretic lower limbs. This study examined the possibility of improving their gait by immobilizing the non-paretic knee joint on extension and promoting weight shifts towards the paretic side.
【Methods】Single-case experiments were conducted, involving 3 hemiparetic patients（Cases 1-3）who had a stroke more than 1 year previously, and required monitoring or lower levels of assistance when walking. The patients walked back and forth along a 5-m course 5 times, with their non-paretic knee joints immobilized on extension using a brace during the intervention（B1,2）periods. Measurement items included：temporal and distance factors（measured with video cameras）；and hip, knee, and ankle joint angles during gait（with electrogoniometers）. The measured temporal and distance factors were analyzed, adopting the two-standard deviation band method.
【Results】In all cases, the stance phase was significantly prolonged on the paretic side during all experimental periods following the first baseline（A1）period. In Cases 2 and 3, the stride length increased after the A1 period；an increased cadence was also observed in Case 3. In Case 1, hip extension in the stance phase improved during all experimental periods following the A1 period, and, in Cases 2 and 3, the knee hyperextension in the stance phase, which was observed during the A1 period, was resolved during the second（A2）and third（A3）baseline periods.
【Discussion】Gait training with non-paretic knee immobilization may promote weight shifts towards the paretic side to overcome a swing limitation on the immobilized side, consequently creating a more efficient, symmetric gait pattern. It was also suggested that improved control of the paretic knee joint with appropriate weight shifts during the intervention/manipulation period may be key to preventing hyper- or limited knee extension during the subsequent baseline periods.
【Methods】Single-case experiments were conducted, involving 3 hemiparetic patients（Cases 1-3）who had a stroke more than 1 year previously, and required monitoring or lower levels of assistance when walking. The patients walked back and forth along a 5-m course 5 times, with their non-paretic knee joints immobilized on extension using a brace during the intervention（B1,2）periods. Measurement items included：temporal and distance factors（measured with video cameras）；and hip, knee, and ankle joint angles during gait（with electrogoniometers）. The measured temporal and distance factors were analyzed, adopting the two-standard deviation band method.
【Results】In all cases, the stance phase was significantly prolonged on the paretic side during all experimental periods following the first baseline（A1）period. In Cases 2 and 3, the stride length increased after the A1 period；an increased cadence was also observed in Case 3. In Case 1, hip extension in the stance phase improved during all experimental periods following the A1 period, and, in Cases 2 and 3, the knee hyperextension in the stance phase, which was observed during the A1 period, was resolved during the second（A2）and third（A3）baseline periods.
【Discussion】Gait training with non-paretic knee immobilization may promote weight shifts towards the paretic side to overcome a swing limitation on the immobilized side, consequently creating a more efficient, symmetric gait pattern. It was also suggested that improved control of the paretic knee joint with appropriate weight shifts during the intervention/manipulation period may be key to preventing hyper- or limited knee extension during the subsequent baseline periods.