Den Otter A R, Geurts A C H, Mulder Th, Duysens J
Sint Maartenskliniek-Research, Nijmegen, The Netherlands.
Clin Neurophysiol. 2006 Jan;117(1):4-15. doi: 10.1016/j.clinph.2005.08.014. Epub 2005 Dec 5.
To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking.
Electromyographic (EMG) data from both legs, maximum walking speed, the amount of swing phase asymmetry and clinical measures were obtained from a group of post-acute patients with hemiparesis, as early as possible after admission in a rehabilitation centre (mean time post-stroke 35 days) and 1, 3, 6, and 10 weeks later, while all patients participated in a regular rehabilitation program. EMG data from the first assessment were compared to those obtained from a group of healthy controls to identify abnormalities in the temporal patterning of muscle activity. Within subject comparisons of patient data were made over time to investigate whether functional gait recovery was accompanied by changes in the temporal patterns muscle (co-)activity.
EMG patterns during the first assessment showed a number of abnormalities on the paretic side, namely abnormally long durations of activity in biceps femoris (BF) during the single support (SS) phase and in gastrocnemius medialis (GM) during the first double support phase (DS1). Furthermore, in both legs a prolongation of the activity was seen in the rectus femoris (RF) during the SS phase. In addition, the duration of BF-RF coactivation was longer on the paretic side than it was in controls. Over time, the level of ambulatory independence, body mobility, and maximum walking speed increased significantly, indicating that substantial improvements in gait ability occurred. Despite these improvements, durations of muscle (co-) activity and the level of swing phase asymmetry did not change during rehabilitation. More specifically, timing abnormalities in muscle (co-)activity that were found during the first assessment did not change significantly, indicating that these aberrations were not an impediment for functional gait improvements.
Normalization of the temporal patterning of gait related muscle activity in the lower extremities is not a prerequisite for functional recovery of gait in patients with post-stroke hemiparesis. Apparently, physiological processes other than improved temporal muscular coordination must be important determinants of the restoration of ambulatory capacity after stroke.
Recovery of walking ability in post-stroke hemiparesis is not necessarily associated with, or dependent on, reorganization in the temporal control of gait related muscle activity. Normalization of the temporal coordination of muscle activity during gait may not be an important clinical goal during post-acute rehabilitation.
确定中风后偏瘫患者步态的功能恢复是否与跑步机行走过程中下肢肌肉活动和共同激活的时间模式变化相一致。
从一组急性后期偏瘫患者中获取双腿的肌电图（EMG）数据、最大行走速度、摆动相不对称程度及临床指标，在患者入住康复中心后尽早进行（中风后平均35天），并在1、3、6和10周后进行，同时所有患者均参与常规康复计划。将首次评估的EMG数据与一组健康对照者的数据进行比较，以确定肌肉活动时间模式的异常。对患者数据进行组内随时间比较，以研究功能性步态恢复是否伴随着肌肉（共同）活动时间模式的变化。
首次评估期间的EMG模式显示患侧存在一些异常，即单支撑（SS）期股二头肌（BF）和首次双支撑期（DS1）内侧腓肠肌（GM）的活动持续时间异常延长。此外，双腿在SS期股直肌（RF）的活动均延长。此外，患侧BF - RF共同激活的持续时间比对照组更长。随着时间的推移，步行独立性、身体活动能力和最大行走速度水平显著提高，表明步态能力有实质性改善。尽管有这些改善，但康复期间肌肉（共同）活动的持续时间和摆动相不对称程度并未改变。更具体地说，首次评估期间发现的肌肉（共同）活动时间异常没有显著变化，表明这些异常并非功能性步态改善的障碍。
下肢与步态相关肌肉活动的时间模式正常化并非中风后偏瘫患者步态功能恢复的先决条件。显然，除了改善肌肉时间协调之外的生理过程必定是中风后步行能力恢复的重要决定因素。
中风后偏瘫患者步行能力的恢复不一定与步态相关肌肉活动时间控制的重组相关或依赖于此。步态期间肌肉活动时间协调的正常化可能不是急性后期康复期间的重要临床目标。
