Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC.
Gait Posture. 2010 Apr;31(4):511-6. doi: 10.1016/j.gaitpost.2010.02.012. Epub 2010 Mar 17.
With the advances in stroke care, the number of high-functioning patients after stroke is increasing. However, existing clinical tools may not be sensitive enough to identify the residual deficits in these patients. The current study aimed to investigate the control of the pelvis, and the joints and end-point of the lower limbs in high-functioning older patients post-stroke during obstacle-crossing using motion analysis techniques. Twenty-four high-functioning older patients following unilateral stroke and fifteen healthy controls walked and crossed obstacles of three different heights. End-point variables (leading toe-clearance and trailing toe-obstacle distance) and crossing pelvic and joint angles were obtained for both limbs during leading limb crossing. Whether leading with the contralesional or ipsilesional limb, the stroke group exhibited significantly different joint kinematics from the controls mainly in the frontal and transverse planes, with greater leading toe-clearance, trailing toe-obstacle distance, and posterior pelvic tilt. None of the end-point and joint variables were significantly different between limbs. High-functioning patients post-stroke appeared to have acquired a specific symmetric kinematic strategy with increased leading toe-clearance during obstacle-crossing, most likely in order to prevent tripping. This symmetric strategy, possibly a consequence of brain reorganization, may help in performing functional activities during which symmetric performance between the contralesional and ipsilesional sides is required. Obstacle-crossing training with both limbs leading alternately may be helpful for the development of this symmetric strategy. It is suggested that computerized motion analysis of obstacle-crossing can be a sensitive assessment tool for distinguishing the motor performance between normal and high-functioning patients post-stroke.
随着中风治疗的进步，中风后高功能患者的数量正在增加。然而，现有的临床工具可能不够敏感，无法识别这些患者的残留缺陷。本研究旨在使用运动分析技术研究高功能老年中风患者在过障时骨盆以及下肢关节和末端的控制情况。24 名单侧中风后高功能老年患者和 15 名健康对照者在过三种不同高度的障碍物时行走和交叉。在过障时，获得了两条腿的末端变量（前足净空和后足与障碍物的距离）和过障骨盆和关节角度。无论是用健侧还是患侧过障，中风组的关节运动学与对照组有明显不同，主要是在前额和横平面上，前足净空、后足与障碍物的距离以及后骨盆倾斜度更大。四肢之间的末端和关节变量均无显著差异。中风后高功能患者似乎已经获得了一种特定的对称运动学策略，在过障时增加了前足净空，这很可能是为了防止绊倒。这种对称策略可能是大脑重组的结果，可能有助于执行需要患侧和健侧对称表现的功能性活动。交替用双腿过障训练可能有助于发展这种对称策略。建议使用计算机化的过障运动分析作为区分正常和中风后高功能患者运动表现的敏感评估工具。
