Objectives: This study investigated the associations between gait velocity and kinematic variables in the first half of the gait cycle according to stroke severity. We performed gait analysis in individuals with stroke, focusing on changes in the center-of-gravity (COG) position on the paretic side in the first half of stance phase.

Methods: Gait data of 80 individuals (20 each in Brunnstrom recovery stage: III, IV, V and VI) with stroke acquired using a 3D motion analysis system was retrospectively analyzed. Associations of gait velocity with the COG positions in the anteroposterior directions and vertical increases in the first half of stance phase on the paretic side were compared according to stroke severity, using correlation analysis.

Results: Gait velocity showed strong positive correlations with step length on the paretic side at initial contact, the rate of vertical increase in the COG during single-leg stance, and the proportion of single-leg stance time in the gait cycle. The associations between velocity and each kinematic variable differed according to stroke severity. Gait velocity was strongly correlated with the rate of vertical increase in the COG during single-leg stance and the proportion of single-leg stance in severe hemiplegia, while a strong correlation was observed with step length on the paretic side in mild hemiplegia.

Conclusion: An upward shift of the COG during single-leg stance was an important factor in gait velocity, and the correlation between gait velocity and the rate of vertical increase in the COG during single-leg stance was stronger when hemiplegia was more severe.

We have experienced a surgeon who had a previous left putaminal hemorrhage and presented with higher brain dysfunctions due to a new right frontal lobe infarction. The patient was a right-handed man in his 50s with inattention, constructive disorder, left hemispatial neglect, and executive dysfunction. The lesions were localized not only in the right inferior and middle frontal gyri but also in deep white matter including the right frontal aslant tract and superior longitudinal fasciculus. The patient gradually resumed work early on with multidisciplinary support and returned to work within 3 months after the onset of the disease. In this case, direct attention training, metacognitive strategy training including time pressure management, and visual search training from the acute stage were successful. Even after the completion of cognitive rehabilitation, an improvement in attention and processing speed was confirmed, suggesting that highly personalized cognitive rehabilitation tailored to higher brain dysfunctions have a lasting effect. However, the improvement of higher brain functions and the resumption of work increased self-awareness and anxiety, leading to a decrease in self-efficacy. Cognitive rehabilitation including metacognitive strategy training, together with psychological support, is important for step-by-step return to work.