Roerdink Melvyn, Lamoth Claudine J C, van Kordelaar Joost, Elich Peter, Konijnenbelt Manin, Kwakkel Gert, Beek Peter J
Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Department of Rehabiliation Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
Neurorehabil Neural Repair. 2009 Sep;23(7):668-78. doi: 10.1177/1545968309332879. Epub 2009 Mar 23.
In rehabilitation, acoustic rhythms are often used to improve gait after stroke. Acoustic cueing may enhance gait coordination by creating a stable coupling between heel strikes and metronome beats and provide a means to train the adaptability of gait coordination to environmental changes, as required in everyday life ambulation.
To examine the stability and adaptability of auditory-motor synchronization in acoustically paced treadmill walking in stroke patients.
Eleven stroke patients and 10 healthy controls walked on a treadmill at preferred speed and cadence under no metronome, single-metronome (pacing only paretic or nonparetic steps), and double-metronome (pacing both footfalls) conditions. The stability of auditory-motor synchronization was quantified by the variability of the phase relation between footfalls and beats. In a separate session, the acoustic rhythms were perturbed and adaptations to restore auditory-motor synchronization were quantified.
For both groups, auditory-motor synchronization was more stable for double-metronome than single-metronome conditions, with stroke patients exhibiting an overall weaker coupling of footfalls to metronome beats than controls. The recovery characteristics following rhythm perturbations corroborated the stability findings and further revealed that stroke patients had difficulty in accelerating their steps and instead preferred a slower-step response to restore synchronization.
In gait rehabilitation practice, the use of acoustic rhythms may be more effective when both footfalls are paced. In addition, rhythm perturbations during acoustically paced treadmill walking may not only be employed to evaluate the stability of auditory-motor synchronization but also have promising implications for evaluation and training of gait adaptations in neurorehabilitation practice.
在康复治疗中，声学节律常被用于改善中风后的步态。声学提示可能通过在足跟撞击与节拍器节拍之间建立稳定的耦合来增强步态协调性，并提供一种方法来训练步态协调性对日常生活行走中所需的环境变化的适应性。
研究中风患者在有节奏的跑步机行走中听觉-运动同步的稳定性和适应性。
11名中风患者和10名健康对照者在跑步机上以偏好的速度和步频行走，分别处于无节拍器、单节拍器（仅为患侧或非患侧脚步设定节奏）和双节拍器（为双脚落地都设定节奏）条件下。听觉-运动同步的稳定性通过脚步落地与节拍之间相位关系的变异性来量化。在另一次测试中，对声学节律进行干扰，并对恢复听觉-运动同步的适应性进行量化。
对于两组而言，双节拍器条件下的听觉-运动同步比单节拍器条件下更稳定，中风患者脚步落地与节拍器节拍的整体耦合比对照组弱。节律干扰后的恢复特征证实了稳定性研究结果，并进一步表明中风患者在加快步伐方面存在困难，而是更倾向于以较慢的步伐反应来恢复同步。
在步态康复实践中，当为双脚落地都设定节奏时，使用声学节律可能更有效。此外，在有节奏的跑步机行走过程中的节律干扰不仅可用于评估听觉-运动同步的稳定性，而且在神经康复实践中对步态适应性的评估和训练也有潜在的应用价值。
