Gait recovery after first-ever ischemic stroke: A pilot observational study

Introduction: Gait impairment is one of the most common and disabling consequences of stroke, significantly limiting functional independence and participation in daily life. Walking speed is widely recognized as a key indicator of functional mobility and a predictor of health outcomes (GBD 2019 Stroke Collaborators, 2021; Middleton et al., 2015). Post-stroke gait is typically characterized by asymmetry, reduced postural control, decreased adaptability, and slower walking speed, all of which negatively affect stability and functional ambulation. Recovery of gait function is most dynamic during the early subacute phase, when neuroplastic mechanisms are most responsive to rehabilitation interventions (Dobkin, 2005). The aim of this study was to describe the six-month trajectory of gait recovery.Methods: This prospective longitudinal single-center feasibility study included 17 patients with first-ever unilateral ischemic stroke (9 men, 8 women; age 67.9 ± 6.9 years) enrolled within <10 days after onset. Participants underwent a standardized two-week intensive inpatient rehabilitation program including physiotherapy, occupational therapy, and assisted treadmill gait training up to 160 minutes daily. Neurological and patient-reported outcomes included the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and EuroQol 5-Dimension 3-Level questionnaire (EQ-5D-3L). Functional outcomes included gait speed (10-Meter Walk Test), lower-limb motor function (FMA-LE), and walking independence (FAC). Outcome measures were assessed at five time points (enrollment, pre-rehabilitation, post-intervention, 3 months, and 6 months). Longitudinal changes were analyzed using repeated-measures MANOVA and linear mixed-effects models (LMMs).Results: Significant improvements were observed across functional and neurological outcomes. MANOVA demonstrated significant effects of time on neurological and patient-reported outcomes (p < 0.001) and functional outcomes (p = 0.003). Walking independence improved significantly (p < 0.001). The largest gains occurred during the two-week rehabilitation period, with gait speed increasing by approximately 0.30 m/s, FMA-LE by 4–5 points, and BI by approximately 25 points. Further improvements were observed up to 3 months, followed by stabilization. LMM analyses identified baseline FMA-LE (p = 0.012) and BI (p < 0.001) as factors associated with gait-speed recovery. Quality of life improved and neurological deficits decreased.Conclusions: Early intensive rehabilitation is associated with rapid and clinically meaningful improvements in gait, motor function, and trunk stability after stroke. Improvements in gait speed are clinically meaningful and are associated with better functional ambulation and quality of life (Perry et al., 1995; Tilson et al., 2010). The most substantial recovery occurs in the early subacute phase, particularly within the first two weeks, followed by slower progression up to six months. These findings highlight the importance of targeting both motor and postural components of gait to enhance functional mobility and independence.