Brach Jennifer S, Studenski Stephanie, Perera Subashan, VanSwearingen Jessie M, Newman Anne B
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, United States.
Gait Posture. 2008 Apr;27(3):431-9. doi: 10.1016/j.gaitpost.2007.05.016. Epub 2007 Jul 13.
Gait variability may have multiple causes. We hypothesized that central nervous system (CNS) impairments would affect motor control and be manifested as increased stance time and step length variability, while sensory impairments would affect balance and be manifested as increased step width variability. Older adults (mean+/-standard deviation (S.D.) age=79.4+/-4.1, n=558) from the Pittsburgh site of the Cardiovascular Health Study participated. The S.D. across steps was the indicator of gait variability, determined for three gait measures, step length, stance time and step width, using a computerized walkway. Impairment measures included CNS function (modified mini-mental state examination, Trails A and B, Digit Symbol Substitution, finger tapping), sensory function (lower extremity (LE) vibration, vision), strength (grip strength, repeated chair stands), mood, and LE pain. Linear regression models were fit for the three gait variability characteristics using impairment measures as independent variables, adjusted for age, race, gender, and height. Analyses were repeated stratified by gait speed. All measures of CNS impairment were directly related to stance time variability (p<0.01), with increased CNS impairment associated with increased stance time variability. CNS impairments were not related to step length or width variability. Both sensory impairments were inversely related to step width (p<0.01) but not step length or stance time variability. CNS impairments affected stance time variability especially in slow walkers while sensory impairments affected step width variability in fast walkers. Specific patterns of gait variability may imply different underlying causes. Types of gait variability should be specified. Interventions may be targeted at specific types of gait variability.
步态变异性可能有多种原因。我们假设中枢神经系统（CNS）损伤会影响运动控制，并表现为站立时间和步长变异性增加，而感觉损伤会影响平衡，并表现为步宽变异性增加。心血管健康研究匹兹堡站点的老年人（平均年龄±标准差（S.D.）=79.4±4.1，n = 558）参与了研究。步幅的标准差是步态变异性的指标，使用计算机化步道针对步长、站立时间和步宽这三种步态测量指标进行测定。损伤测量包括中枢神经系统功能（改良简易精神状态检查、A和B连线测验、数字符号替换、手指敲击）、感觉功能（下肢（LE）振动、视力）、力量（握力、重复起坐）、情绪和下肢疼痛。使用损伤测量指标作为自变量，针对三种步态变异性特征拟合线性回归模型，并对年龄、种族、性别和身高进行了调整。按步态速度分层重复进行分析。所有中枢神经系统损伤测量指标均与站立时间变异性直接相关（p<0.01），中枢神经系统损伤增加与站立时间变异性增加相关。中枢神经系统损伤与步长或步宽变异性无关。两种感觉损伤均与步宽呈负相关（p<0.01），但与步长或站立时间变异性无关。中枢神经系统损伤尤其影响慢行者的站立时间变异性，而感觉损伤影响快行者的步宽变异性。特定的步态变异性模式可能意味着不同的潜在原因。应明确步态变异性的类型。干预措施可针对特定类型的步态变异性。
