Influences of Gait Training with Knee–Ankle–Foot Orthosis on Gait Ability and Independence in Severe Hemiplegia and Pusher Behavior with Unilateral Spatial Neglect Following Stroke: A Retrospective Historical Controlled Study

PMCID: PMC12177197

PMID: 40534213

DOI: 10.1002/brb3.70535

Journal: Brain and behavior

Publication Date: 2025-6-18

Authors: Sawa K, Tamura M, Arai S

Key Points

• Long-term KAFO intervention showed differential improvements across stroke patient subgroups
• Days since stroke onset and sensorimotor variability were critical predictors of gait independence (p < 0.05)
• Pusher syndrome and USN patients demonstrated more limited functional recovery despite orthotic intervention

Summary

This longitudinal study investigated the impact of knee-ankle-foot orthoses (KAFOs) on gait independence and functional recovery in post-stroke patients with severe hemiplegia, pusher syndrome, and unilateral spatial neglect (USN). The research compared 44 patients (22 in each group) who used KAFOs for at least 3 months during rehabilitation, with carefully matched demographic characteristics.

The study revealed nuanced outcomes in orthotic intervention, demonstrating modest improvements in gait ability. For severe hemiplegia patients, key prognostic factors included days since stroke onset and sensorimotor performance variability (SPV), while USN patients were primarily influenced by eye-opening (SPV-EO) variability errors. Notably, the pusher group showed significantly less improvement in gait independence at discharge compared to the severe hemiplegia group, highlighting the complex neurological challenges in post-stroke rehabilitation.