Chang H A, Chuang T Y, Lee S J, Liao S F, Lee H C, Shih Y H, Cheng H
Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taiwan.
Spinal Cord. 2004 May;42(5):281-9. doi: 10.1038/sj.sc.3101587.
Comparison group design.
To compare the temporal distance factors during gait initiation between patients with incomplete cervical spinal cord injury, incomplete lumbosacral spinal lesion, and unimpaired control adults.
Human performance and movement analysis laboratory, Taiwan.
Five patients with an incomplete cervical spinal cord injury (Group 1), five patients with an incomplete lumbosacral spinal lesion (Group 2) and nine unimpaired control adults (Group 3).
Subjects underwent a three-dimensional gait analysis. The total gait initiation period, reaction time, each relative phasing of gait initiation and the length of the first step were identified by using the kinematic measurement system.
The total gait initiation period (start of the auditory cue for gait initiation to heel-strike of the first swing leg); each relative phasing of gait initiation indicated that the duration of the preparatory phase (start of auditory cue for gait initiation to heel-off of the first swing leg), the duration of the push-up phase (heel-off to toe-off of the first swing leg), and the duration of the single-stance phase (toe-off to heel-strike of the first swing leg) established by the total gait initiation period; and the length of the first step.
The gait initiation period was greater in Groups 1 and 2 than that of Group 3 (P<0.05). Each relative phasing including the duration of the preparatory phase, the push-up phase, and the swing phase relative to the total gait initiation period, did not differ among Groups 1-3 (P>0.05). The length of the first step, measured while the nonpreferred leg stepped first in Groups 1 and 2, was shorter than that of Group 3 (P<0.05).
Patients with incomplete cervical spinal cord injuries or lumbosacral spinal lesions took more time in gait initiation than unimpaired control adults. The first step length also reduced in these patients while the nonpreferred leg stepped first, as compared to unimpaired control adults. The data indicated that centrally programmed gait initiation might be preserved in ASIA-D spinal patients who, in this study, executed gait initiation with varying temporal distance strategies to compensate for peripheral impairments, as compared to unimpaired control adults.
比较组设计。
比较不完全性颈脊髓损伤患者、不完全性腰骶部脊髓损伤患者和未受损对照成年人在步态起始过程中的时间距离因素。
台湾人体运动表现与运动分析实验室。
5例不完全性颈脊髓损伤患者（第1组）、5例不完全性腰骶部脊髓损伤患者（第2组）和9例未受损对照成年人（第3组）。
受试者接受三维步态分析。使用运动测量系统确定总的步态起始期、反应时间、步态起始的每个相对相位以及第一步的长度。
总的步态起始期（步态起始听觉提示开始至第一条摆动腿足跟触地）；步态起始的每个相对相位表明由总的步态起始期确定的准备期（步态起始听觉提示开始至第一条摆动腿足跟离地）的持续时间、上推期（第一条摆动腿足跟离地至足趾离地）的持续时间和单支撑期（第一条摆动腿足趾离地至足跟触地）的持续时间；以及第一步的长度。
第1组和第2组的步态起始期长于第3组（P<0.05）。第1 - 3组之间，包括准备期、上推期和相对于总步态起始期的摆动期持续时间在内的每个相对相位无差异（P>0.05）。第1组和第2组中以非优势腿先迈步时测量的第一步长度短于第3组（P<0.05）。
不完全性颈脊髓损伤或腰骶部脊髓损伤患者在步态起始时比未受损对照成年人花费更多时间。与未受损对照成年人相比，这些患者在以非优势腿先迈步时第一步长度也缩短。数据表明，与未受损对照成年人相比，在本研究中采用不同时间距离策略执行步态起始以补偿周围损伤的亚洲损伤量表D级脊髓损伤患者，其中枢编程的步态起始可能得以保留。
