Lu Tung-Wu, Yen Hsiao-Ching, Chen Hao-Ling
Institute of Biomedical Engineering, National Taiwan University, Taiwan.
Gait Posture. 2008 Feb;27(2):309-15. doi: 10.1016/j.gaitpost.2007.04.007. Epub 2007 May 17.
Fifteen normal adults walked and crossed obstacles of different heights (10%, 20% and 30% of leg length) with each limb while kinematic data were measured to obtain joint angles in the sagittal plane. Phase angles of each joint were calculated from the angular velocities (x') and displacements (x) as phi=tan(-1)(x'/x). Relative phase angles were then calculated by subtracting phase angles of a distal joint from the proximal joint (phi(hip-knee), phi(knee-ankle)). The standard deviations of the relative phase curve points for the stance and swing phase for each obstacle height were averaged to obtain the respective deviation phase (DP) values. The calculated DP variables were tested using a two-factor repeated ANOVA. The leading and trailing limbs were found to have similar patterns of inter-joint coordination, but different levels of stability, the leading being more stable than the trailing during swing (p<0.05), while only leading knee-ankle coordination was less stable than that of the trailing during stance (p<0.05). Only the stability of the knee-ankle coordination for both limbs decreased with increasing obstacle height during stance (p<0.05). It is suggested that clinical obstacle-crossing training programs for patients with unilateral pathology should include the training of the affected limb, not only as leading but also as trailing limb. An increase of the stability of the ankle joint may be helpful for the stability of the knee-ankle coordination and thus for the general performance of obstacle-crossing.
15名正常成年人分别用每条腿行走并跨越不同高度（腿长的10%、20%和30%）的障碍物，同时测量运动学数据以获取矢状面内的关节角度。每个关节的相位角根据角速度（x'）和位移（x）计算得出，公式为phi=tan(-1)(x'/x)。然后通过从近端关节减去远端关节的相位角来计算相对相位角（phi(髋-膝)，phi(膝-踝)）。对每个障碍物高度的站立期和摆动期相对相位曲线点的标准差进行平均，以获得各自的偏差相位（DP）值。使用双因素重复方差分析对计算出的DP变量进行检验。结果发现，领先腿和落后腿的关节间协调模式相似，但稳定性水平不同，领先腿在摆动期比落后腿更稳定（p<0.05），而只有领先腿的膝-踝协调在站立期比落后腿的稳定性差（p<0.05）。在站立期，随着障碍物高度增加，双腿的膝-踝协调稳定性均下降（p<0.05）。建议针对单侧病变患者的临床跨越障碍物训练计划应包括对患侧肢体的训练，不仅要训练其作为领先腿，还要训练其作为落后腿。增加踝关节的稳定性可能有助于膝-踝协调的稳定性，从而有助于跨越障碍物的整体表现。
