Sullivan Katherine, Klassen Tara, Mulroy Sara
Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA.
J Neurol Phys Ther. 2006 Sep;30(3):130-41. doi: 10.1097/01.npt.0000281950.86311.82.
Task-specific and strength training have demonstrated efficacy as therapeutic interventions poststroke. The intent of this case study is to describe outcomes associated with a therapy program that combines task-specific and strength training in an individual post-stroke and to discuss some possible mechanisms and modulating factors that may affect post-stroke neurologic recovery and responsiveness to intervention.
The participant was a 38-year-old female with right middle cerebral artery stroke, evaluated 15 months postonset. She ambulated independently with an ankle-foot orthosis and straight cane. Her free and fast overground velocity was 0.50 m/s and 0.62 m/s, respectively. Body-weight supported treadmill training and a limb-loaded cycling exercise were alternated over 24 treatments sessions (4 times/wk for 6 wks). Measurements were taken pre-, post-treatment, and at a 6-mo follow-up. Instrumented gait and motion analysis with fine-wire EMG recording of LE muscle activity occurred pre- and post-treatment.
Post-treatment, walking speed increased 18% for free--(0.59 m/ s) and 14.4% for fast-velocity (0.71 m/s); 6-min walking distance increased 4% (184.4 m). At 6-mos, continued improvements in all walking outcomes were evident. Gait and motion analysis revealed that functional locomotor recovery was associated with increases in magnitude of paretic leg gluteus maximus and gluteus medius activation during gait. Motion analysis confirmed an increase of hip and knee extension motions throughout stance and swing.
For the person in this case clinically meaningful changes in walking function were associated with a combined therapeutic program that included both task-specific and LE strength training. Possible mechanisms associated with response to therapy were related to improved motor unit activation associated with increased strength in key muscles used in gait.
特定任务训练和力量训练已被证明是中风后有效的治疗干预措施。本病例研究的目的是描述与一项针对中风个体的将特定任务训练和力量训练相结合的治疗方案相关的结果，并讨论一些可能影响中风后神经恢复及对干预反应性的潜在机制和调节因素。
参与者为一名38岁女性，患有右大脑中动脉中风，发病15个月后接受评估。她佩戴踝足矫形器并使用直手杖独立行走。她的自由行走速度和快速行走速度分别为0.50米/秒和0.62米/秒。在24次治疗疗程（每周4次，共6周）中交替进行减重平板训练和肢体负重骑行运动。在治疗前、治疗后及6个月随访时进行测量。在治疗前和治疗后采用仪器化步态和运动分析，并通过细针肌电图记录下肢肌肉活动。
治疗后，自由行走速度提高了18%（至0.59米/秒），快速行走速度提高了14.4%（至0.71米/秒）；6分钟步行距离增加了4%（至184.4米）。在6个月时，所有步行结果均持续改善。步态和运动分析显示，功能性运动恢复与步态中患侧腿臀大肌和臀中肌激活幅度增加有关。运动分析证实，在整个站立期和摆动期，髋部和膝部伸展运动增加。
对于本病例中的患者，步行功能的临床意义上的改变与一项包括特定任务训练和下肢力量训练的联合治疗方案相关。与治疗反应相关的可能机制与关键步态肌肉力量增加导致的运动单位激活改善有关。
