Galna Brook, Peters Alana, Murphy Anna T, Morris Meg E
School of Physiotherapy, Melbourne Physiotherapy School, Melbourne, Australia.
Gait Posture. 2009 Oct;30(3):270-5. doi: 10.1016/j.gaitpost.2009.05.022. Epub 2009 Jul 21.
This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions.
本系统综述和文献批判性评价探讨了高龄是否会在无时间限制和有时间限制的情况下对跨越障碍物产生不利影响。通过检索八个电子数据库，查找标题、摘要或关键词中包含与行走过程中跨越障碍物相关术语的文章。从最初检索到的727篇文章中筛选出15篇进行综述。由两名评审员对每篇文章的方法学质量进行评判并提取数据。研究表明，当有足够时间来调整足部相对于障碍物的放置位置时，年轻人和老年人与障碍物接触的频率都较低。当调整足部轨迹的时间较少时，老年人比年轻人更频繁地接触障碍物。老年人采用了更缓慢、更保守的跨越障碍物策略。他们在步态摆动期，前导肢和后随肢的髋关节屈曲幅度更大；在站立期，前导肢和后随肢的髋关节屈曲、髋关节内收和踝关节背屈幅度也更大。此外，有证据表明，在老年人跨越障碍物步态周期的关键事件中，髋关节和踝关节的内力矩有所降低。尽管老年人采用了更保守的跨越障碍物策略，但在有时间限制的情况下，他们接触障碍物的风险更高。
