Changes in Gait Metrics and Motor Strategies Post-Neurocognitive Rehabilitation in Subacute Stroke: A Retrospective Mixed-Methods Study

Background It is known that neurocognitive rehabilitation (NCR) improves post-stroke functional outcomes. However, systematic evaluations of changes in stride regularity and step regularity remain limited. Furthermore, a few studies have combined quantitative gait metrics with qualitative analyses of self-reported motor strategies, particularly in individuals with subacute stroke. Objective To examine immediate changes in key gait metrics - specifically vertical stride regularity and walking speed - as well as self-reported motor strategies following a single-session NCR intervention targeting hip and trunk proprioception in individuals with subacute stroke using a retrospective observational design. Methods Using a convergent mixed-methods design within a retrospective framework, we concurrently analyzed quantitative gait and qualitative interview data, which were subsequently integrated during the interpretation phase. Clinical data from 39 patients with subacute stroke were analyzed. Each participant underwent a single-session NCR intervention. Clinical records included trunk accelerometry-based gait assessments and self-reported motor strategies collected through semi-structured interviews. Quantitative gait data were analyzed as time series, and qualitative interview data were processed using text mining techniques. The findings were integrated via correspondence analysis, with patients categorized based on the percentage change in vertical stride regularity from baseline to immediately post-intervention. Results Statistically significant immediate changes in stride regularity (vertical and anteroposterior axes) and step regularity (vertical, mediolateral, and anteroposterior axes) were observed from pre- to post-intervention (T0 to T1), with medium to large effect sizes. Gait speed showed a statistically significant increase post-intervention to the following day (T1 to T2). Co-occurrence network analysis of interview data revealed a shift in reported motor strategies post-intervention, from distal segments (such as "feet" and "toes") to proximal segments (such as "hip joint," "waist," and "trunk"). The correspondence analysis suggested that patients with greater changes in vertical stride regularity described strategies emphasizing proximal control, whereas those with smaller changes referenced distal segments or fall prevention-oriented strategies. Conclusions A single session of NCR focusing on hip and trunk proprioception was associated with immediate changes in gait regularity and symmetry, as well as patients' awareness of their motor strategies in subacute stroke. The integration of objective and subjective assessments may support more personalized rehabilitation planning. Prospective studies are warranted to further investigate these findings.