Hesse Stefan
Klinik Berlin, Department of Neurological Rehabilitation, Charité-University Medicine Berlin, Germany.
NeuroRehabilitation. 2008;23(1):55-65.
Restoration and improvement of gait after stroke are major aspects of neurorehabilitation. Mobilization out of the bed into the wheelchair and verticalisation with the help of a standing frame are first steps. With the patient cardiovascular stable, gait restoration is put on the agenda. Instead of tone-inhibiting and gait preparatory maneuvers, patients should practice complex gait cycles repetitively. Treadmill training with partial body weight support enables the harness-secured patients to practice numerous steps assisted by two or three therapists. In controlled studies, it proved equally effective as walking on the floor. Gait machines, as the Lokomat or the Gait Trainer GTI, intend to relieve the strenuous effort for the therapists. For the GTI, several controlled trials showed a superior effect in acute stroke patients with respect to walking ability and velocity. For the ambulatory patient, aerobic treadmill training is effective to improve speed and endurance without worsening gait quality. Belt velocity and inclination are gradually increased so that the patients reach a predefined target heart rate. On the belt, patients walk more symmetrically, and higher velocities result in a facilitation of paretic muscles and render gait more efficient. In summary, gait rehabilitation has seen dramatic changes over the last years. More is to be expected.
中风后步态的恢复和改善是神经康复的主要方面。从床上转移到轮椅上并借助站立架实现直立是第一步。在患者心血管状况稳定后，步态恢复便被提上日程。患者不应进行抑制肌张力和准备步态的动作，而应反复练习复杂的步态周期。部分体重支撑的跑步机训练能让系着安全带的患者在两三名治疗师的协助下练习大量步数。在对照研究中，它被证明与在地面行走同样有效。步态训练机，如Lokomat或步态训练器GTI，旨在减轻治疗师的繁重工作。对于GTI，多项对照试验表明，在急性中风患者的步行能力和速度方面，它具有更好的效果。对于能够行走的患者，有氧跑步机训练可有效提高速度和耐力，且不会使步态质量恶化。传送带速度和倾斜度会逐渐增加，以便患者达到预定的目标心率。在传送带上，患者行走更加对称，更高的速度会促进瘫痪肌肉的活动，使步态更有效率。总之，在过去几年里，步态康复发生了巨大变化。未来值得期待。
