Merati G, Sarchi P, Ferrarin M, Pedotti A, Veicsteinas A
Center of Sports Medicine, don C. Gnocchi Foundation, IRCCS, Milan, Italy.
Spinal Cord. 2000 Jan;38(1):37-44. doi: 10.1038/sj.sc.3100946.
To study the energy cost of locomotion during ambulation with different orthoses (HIP Guidance Orthosis Orlau Parawalker (PW), n=4; Reciprocating Gait Orthosis (RGO), n=6; RGO + FNS, n=4).
Since high energy costs of locomotion have been proposed as a major reason for early rejection of orthotic use, our aims were (a) to evaluate the impact of functional neuromuscular stimulation (FNS) on energy expenditure during orthosis-assisted ambulation; (b) to study whether energy expenditure data can predict the poor long-term patients' compliance and (c) to assess selection criteria for the assignment of the different types of orthosis.
The study was completed at the Center of Sports Medicine and Center of Bioengineering, don C. Gnocchi Foundation, IRCCS, Milan, Italy.
The HR/VO2 relationship and the energy cost of locomotion (C) were studied in 14 patients (lesion level C7-T11) during wheelchair (WHCH) use at various speeds and during locomotion with different orthotic devices. Patients' short- and long-term compliance were assessed by questionnaires evaluating duration of and problems related to orthotic use.
(a) In patients using RGO + FNS the slope difference of HR/VO2 curves (deltaslHR/VO2) between WHCH and orthosis was significantly lower than in other groups (-3 beats l(-1) in RGO + FNS vs 43 and 52 beats l(-1) in RGO and PW, respectively); (b) neither C, nor VO2 peak, or deltaslHR/VO2 correlated with orthosis duration of use; (c) in the RGO + FNS group, C was lower at maximal walking speed, which linearly correlated with maximal WHCH speed.
(a) Electrical stimulation seems to improve locomotion, as a consequence of hemodynamic effects, but does not decrease energy expenditure, which remains high; (b) the poor long-term compliance to orthosis use cannot be predicted by the energy expenditure parameters; (c) the subjects who can reach high speeds by WHCH seem to be the most appropriate for RGO + FNS locomotion.
研究使用不同矫形器（髋部引导矫形器Orlau Parawalker（PW），n = 4；往复式步态矫形器（RGO），n = 6；RGO + FNS，n = 4）行走时的运动能量消耗。
由于运动能量消耗高被认为是早期拒绝使用矫形器的主要原因，我们的目的是（a）评估功能性神经肌肉电刺激（FNS）对矫形器辅助行走时能量消耗的影响；（b）研究能量消耗数据是否可以预测患者长期依从性差；（c）评估不同类型矫形器分配的选择标准。
该研究在意大利米兰don C. Gnocchi基金会IRCCS运动医学中心和生物工程中心完成。
在14例（损伤平面C7 - T11）患者使用轮椅（WHCH）以不同速度行驶以及使用不同矫形器行走期间，研究心率/摄氧量关系和运动能量消耗（C）。通过评估矫形器使用持续时间和相关问题的问卷来评估患者的短期和长期依从性。
（a）使用RGO + FNS的患者，WHCH和矫形器之间心率/摄氧量曲线的斜率差异（deltaslHR/VO2）显著低于其他组（RGO + FNS组为 - 3次/升，RGO组和PW组分别为43次/升和52次/升）；（b）C、摄氧量峰值或deltaslHR/VO2均与矫形器使用持续时间无关；（c）在RGO + FNS组中，最大行走速度时C较低，且与最大WHCH速度呈线性相关。
（a）电刺激似乎因血流动力学效应而改善运动，但不会降低能量消耗，能量消耗仍然很高；（b）能量消耗参数无法预测患者长期使用矫形器的依从性差；（c）通过WHCH能达到高速的受试者似乎最适合RGO + FNS运动。
