Yen Chu-Ling, Wang Ray-Yau, Liao Kwong-Kum, Huang Chia-Chi, Yang Yea-Ru
Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan.
Neurorehabil Neural Repair. 2008 Jan-Feb;22(1):22-30. doi: 10.1177/1545968307301875. Epub 2007 May 16.
Numerous studies have reported the effects of gait training on motor performance after stroke. However, there is limited information on treatment-induced changes in corticomotor excitability.
The purpose of the study was to investigate the effects of additional gait training on motor performance and corticomotor excitability and to demonstrate the relationship between motor improvement and corticomotor excitability change in patients with chronic stroke.
Fourteen patients were randomly assigned to the experimental or control group. Participants in both groups participated in general physical therapy. Those in the experimental group received additional body weight- supported treadmill training for 4 weeks. All participants received baseline and posttreatment assessments. The outcome measures included assessment of the Berg Balance Scale (BBS) and gait parameters. Focal transcranial magnetic stimulation was used to measure the motor threshold, map size, and location of the amplitude-weighted center of gravity of the motor map for the tibialis anterior (TA) and abductor hallucis (AH) muscles.
After general physical therapy, we noted that the patients showed an improvement only in walking speed and cadence, and there were no significant changes in corticomotor excitability. After additional gait training, participants improved significantly on BBS score, walking speed, and step length. Moreover, the motor threshold for TA decreased significantly in the unaffected hemisphere. The map size for TA was increased in both hemispheres, whereas that for AH was increased only in the affected hemisphere. There were significant differences between the change scores of the groups in terms of walking speed, step length, and motor threshold for TA in the unaffected hemisphere and map size for AH in the affected hemisphere. Additionally, the changes in corticomotor excitability correlated with functional improvement.
Additional gait training may improve balance and gait performance and may induce changes in corticomotor excitability.
众多研究报告了步态训练对中风后运动表现的影响。然而，关于治疗引起的皮质运动兴奋性变化的信息有限。
本研究旨在探讨额外的步态训练对运动表现和皮质运动兴奋性的影响，并阐明慢性中风患者运动改善与皮质运动兴奋性变化之间的关系。
14名患者被随机分配至实验组或对照组。两组参与者均接受常规物理治疗。实验组参与者接受额外的体重支持下的跑步机训练，为期4周。所有参与者均接受基线和治疗后评估。结果指标包括Berg平衡量表（BBS）评估和步态参数。采用局灶性经颅磁刺激测量运动阈值、运动映射大小以及胫骨前肌（TA）和拇收肌（AH）运动映射的振幅加权重心位置。
常规物理治疗后，我们发现患者仅在步行速度和步频方面有所改善，皮质运动兴奋性无显著变化。额外的步态训练后，参与者在BBS评分、步行速度和步长方面有显著改善。此外，未受影响半球的TA运动阈值显著降低。TA的运动映射大小在两个半球均增加，而AH的运动映射大小仅在受影响半球增加。两组在步行速度、步长、未受影响半球TA的运动阈值以及受影响半球AH的运动映射大小的变化评分方面存在显著差异。此外，皮质运动兴奋性的变化与功能改善相关。
额外的步态训练可能改善平衡和步态表现，并可能引起皮质运动兴奋性的变化。
