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H. Migita1, Y. Tsubouchi1, K. Takahashi1,2, Y. Takeo1,3, K. Inoue1, T. Harada4, S. Ikeda1, M. Fujiki1
1Oita University Hospital, Department of Rehabilitation, Yufu, Japan, 2Oita University Graduate School of Medicine, Department of Medical Science, Yufu, Japan, 3Oita University Graduate School of Welfare and Health Sciences, Department of Welfare and Health Sciences, Oita, Japan, 4Kagoshima University Hospital, Department of Rehabilitation, Kagoshima, Japan
Background: There is a high risk of falls within the first 6 months after a stroke. Stroke patients are twice as likely to fall as able-bodied people. To determine fall risk and balance in patients, the Timed Up and Go test and gait speed tests are often used. While these evaluations are simple and practical to use, they do not allow for accurate measurement of detailed motion characteristics and thus make it difficult to determine the most appropriate physiotherapy for patients. Furthermore, stroke recovery research seldom targets children and adolescents, with case studies often describing adult and elderly patients.
Purpose: The purpose of this study is to observe and evaluate the detailed changes in gait and balance parameters of an 11-year old patient for 1 year after a cerebral infarction.
Methods: The subject was an 11-year-old girl hospitalized for reversible cerebral vasoconstriction syndrome. Her magnetic resonance imaging showed infarction and narrowing in the right middle cerebral artery. Her postural stability and gait were evaluated with a perturbation-based training/body sway meter and an accelerometer five times between the first month after her stroke to 12 months: at the first month, second month, sixth month, ninth month, and twelfth month. To assess balance, the Index of Postural Stability (IPS) was calculated after measuring the mean center of the gravity sway area and of the stability limit. For gait analysis, triaxial accelerometers were attached to the patient’s third lumbar spinous process and both calcaneal prominences, and trunk acceleration data for 10 gait cycles were extracted. Root Mean Square (RMS), Stride-to-stride Time Variability (STV), Lissajous Index (LI), and Jerk RMS (Jerk) were calculated for each analysis.
Results: On the IPS, there was no improvement from 1 month (1.49) to 2 months (1.19) after onset, followed by a significant improvement by 6 months (2.11) after the infarction. When we compared the constitution of the 6-month IPS score with that at 1 month, both the areas of gravitational sway (1 month: 2.63 cm2 vs. 6 months: 0.81 cm2) and the stability limit (1 month: 79.0 cm2 vs. 6 months: 103.7 cm2) improved. There was no major change between the IPS at 6 months and at 12 months (1.99). Gait analysis showed a significant improvement in RMS from 1 month (6.04 m/s2) to 2 months (3.56 m/s2) and then to 6 months (2.59 m/s2), after which it continued slow improvement. On the other hand, LI and Jerk showed improvement until 9 months after onset. STV was at a low level for 1 month (1.68%), a higher level at two months (2.58%), and then showed a low level again at 12 months (1.87%).
Conclusion(s): We suggest the improvement of gait in stroke patients is a process in which balance and gait stability improve first, followed by improved symmetry of gait and finally becoming a fixed gait pattern.
Implications: This study demonstrates a detailed process for the improvement of gait capacity and balance in a young stroke patient. The results suggest rehabilitation programs consider appropriate time and methods for goals based on this data.
Funding, acknowledgements: There is no funding as it is a case study.
Keywords: Stroke, Gait analysis, Balance
Topic: Neurology: stroke
Did this work require ethics approval? No
Institution: Oita University
Committee: Oita University Medical Ethics Committee
Reason: It was not a scientific trial, just a continuous evaluation to support a case report, therefore needing no ethical approval.
All authors, affiliations and abstracts have been published as submitted.
