Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E Imperial Hwy, Bldg 800, Room 33, Downey, CA 90242, USA.
Phys Ther. 2010 Feb;90(2):209-23. doi: 10.2522/ptj.20090141. Epub 2009 Dec 18.
Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed.
The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT).
A prospective, between-subjects design was used.
Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group).
Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention.
Only sagittal-plane parameters were assessed, and the sample size was small.
Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.
脑卒中后的专项训练计划可改善步行功能，但目前尚不清楚步态的哪些生物力学参数与步行速度的提高相关性最大。
本研究旨在确定与包括减重步行训练（BWSTT）在内的运动训练方案后步行速度提高相关的步态参数。
前瞻性、组间设计。
15 名脑卒中后 9 个月至 5 年的患者完成了 3 种不同的 6 周训练方案中的 1 种。这些方案包括 12 次 BWSTT 与 12 次交替进行的下肢抗阻踏车训练、下肢渐进抗阻力量训练或上肢功率车假训练。在 6 周干预方案前后进行步态分析。当参与者以自我选择的速度行走时，从偏瘫下肢记录运动学、动力学和肌电图（EMG）活动。将在自我选择步行速度增加大于 0.08 m/s（高反应组）的参与者与改善较小的参与者（低反应组）的步态参数变化进行比较。
与低反应组相比，高反应组干预后在支撑末期髋关节伸展角度和髋关节屈曲功率（关节净力矩和角速度的乘积）方面有更大的增加。干预后高反应组参与者在行走过程中比目鱼肌的 EMG 活动强度也显著增加。
仅评估矢状面参数，且样本量较小。
与力量训练交替进行的专项运动训练导致了与步行速度提高密切相关的运动学、动力学和肌肉激活适应性改变。在末期支撑阶段髋关节和踝关节生物力学的变化与步行速度的更大提高有关。
