Patterson Shawnna L, Forrester Larry W, Rodgers Mary M, Ryan Alice S, Ivey Frederick M, Sorkin John D, Macko Richard F
Department of Neurology, Baltimore Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
Arch Phys Med Rehabil. 2007 Jan;88(1):115-9. doi: 10.1016/j.apmr.2006.10.025.
To investigate the relationship of cardiovascular fitness (Vo(2)peak), neurologic deficits in balance and leg strength, and body composition to ambulatory function after stroke and to determine whether these relationships differ between those with milder versus more severe gait deficits.
Cross-sectional correlation study.
Outpatient clinic of an academic medical center.
Seventy-four people (43 men, 31 women; mean age +/- standard deviation, 64+/-10y) with chronic hemiparetic stroke.
Not applicable.
Thirty-foot (9.1-m) walk velocity, 6-minute walk distance, Vo(2)peak, Berg Balance Scale score, bilateral quadriceps eccentric torque, total and regional lean mass, and percentage of fat mass.
Short-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, percentage of body fat, and paretic lean mass but not with nonparetic lean mass. Long-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, and paretic lean mass but not with percentage of body fat or nonparetic lean mass. Stepwise regression showed that cardiovascular fitness, balance, and paretic leg strength were independently associated with long-distance walking (r(2)=.60, P<.001). Variance in long-distance walking was largely explained by balance for those who walked more slowly (<.48m/s) for short distances (r(2)=.42, P<.001) and by cardiovascular fitness for those who walked more quickly (>.48m/s) for short distances (r(2)=.26, P=.003).
Short-distance walking after stroke is related to balance, cardiovascular fitness, and paretic leg strength. Long-distance walking ability differs by gait deficit severity, with balance more important in those who walk more slowly and cardiovascular fitness playing a greater role in those who walk more quickly. Improved understanding of the factors that predict ambulatory function may assist the design of individualized rehabilitation strategies across the spectrum of gait deficit severity in those with hemiparetic stroke.
探讨心血管适能（最大摄氧量）、平衡及腿部力量方面的神经功能缺损、身体成分与卒中后步行功能之间的关系，并确定这些关系在步态缺损较轻与较重者之间是否存在差异。
横断面相关性研究。
一所学术医疗中心的门诊。
74例慢性偏瘫性卒中患者（43例男性，31例女性；平均年龄±标准差，64±10岁）。
不适用。
30英尺（9.1米）步行速度、6分钟步行距离、最大摄氧量、伯格平衡量表评分、双侧股四头肌离心扭矩、全身及局部瘦体重、脂肪质量百分比。
短距离步行与心血管适能、平衡、患侧腿部力量、健侧腿部力量、体脂百分比及患侧瘦体重显著相关，但与健侧瘦体重无关。长距离步行与心血管适能、平衡、患侧腿部力量、健侧腿部力量及患侧瘦体重显著相关，但与体脂百分比及健侧瘦体重无关。逐步回归分析显示，心血管适能、平衡及患侧腿部力量与长距离步行独立相关（r² = 0.60，P < 0.001）。对于短距离步行较慢（< 0.48米/秒）的患者，长距离步行的差异主要由平衡因素解释（r² = 0.42，P < 0.001）；而对于短距离步行较快（> 0.48米/秒）的患者，长距离步行的差异主要由心血管适能解释（r² = 0.26，P = 0.003）。
卒中后的短距离步行与平衡、心血管适能及患侧腿部力量有关。长距离步行能力因步态缺损严重程度而异，对于步行较慢者平衡更为重要，而对于步行较快者心血管适能发挥更大作用。更好地理解预测步行功能的因素可能有助于为偏瘫性卒中患者在不同步态缺损严重程度范围内设计个性化的康复策略。
