Hesse S, Jahnke M T, Schaffrin A, Lucke D, Reiter F, Konrad M
Klinik Berlin, Department of Neurological Rehabilitation, Free University, Germany.
Electroencephalogr Clin Neurophysiol. 1998 Dec;109(6):515-22. doi: 10.1016/s1388-2457(98)00033-9.
Although the neurodevelopmental technique (Bobath) is the most widely used approach in the gait rehabilitation of hemiparetic subjects in Europe, there is little neurophysiological evidence for its presumed effects on gait symmetry and facilitation of paretic muscles during the therapeutic intervention. The study, therefore, investigated the immediate effects of gait entrainment by a physical therapist on the gait of hemiparetic subjects.
Cycle parameters, gait symmetry, hip joint movement and the electromyographic activity of several lower limb muscles were assessed in 22 patients during a classic intervention by five Bobath therapists and while walking with and without a cane.
Multivariate statistics revealed that, while being assisted by the therapist, patients walked faster (P = 0.022), with a longer relative stance period of the affected leg (P = 0.005), a higher symmetry (P = 0.002), larger hip extension (P = 0.001) and more activation (P = 0.026) of the Mm. triceps surae, vastus lateralis, biceps femoris and gluteus medius as compared to walking with and without a cane. Extensor spasticity of the plantar-flexor tended to increase (n.s.). In five subjects, no after-effect could be documented 1 h after a gait training of 30 min.
The study confirmed a more balanced walking pattern in conjunction with facilitation of various weight bearing muscles during the therapeutic intervention. A prolonged single stance period of the affected leg, an unobstructed hip movement, enhanced weight acceptance and a faster gait seemed to be responsible for the observed immediate effects of the therapeutic intervention.
尽管神经发育技术（Bobath技术）是欧洲偏瘫患者步态康复中使用最广泛的方法，但在治疗干预期间，其对步态对称性和瘫痪肌肉促进作用的假定效果几乎没有神经生理学证据。因此，本研究调查了物理治疗师进行步态同步训练对偏瘫患者步态的即时影响。
在5名Bobath治疗师进行的经典干预期间，以及使用和不使用拐杖行走时，对22名患者的周期参数、步态对称性、髋关节运动和几块下肢肌肉的肌电图活动进行了评估。
多变量统计显示，在治疗师的协助下，与使用和不使用拐杖行走相比，患者行走速度更快（P = 0.022），患侧腿相对站立期更长（P = 0.005），对称性更高（P = 0.002），髋关节伸展更大（P = 0.001），腓肠肌、股外侧肌、股二头肌和臀中肌的激活更多（P = 0.026）。跖屈肌的伸肌痉挛有增加趋势（无统计学意义）。在5名受试者中，30分钟的步态训练1小时后未记录到后效应。
该研究证实，在治疗干预期间，结合促进各种负重肌肉，可形成更平衡的行走模式。患侧腿延长的单支撑期、无障碍的髋关节运动、增强的负重能力和更快的步态似乎是治疗干预观察到的即时效果的原因。
