老年人移动能力受损者的步态生物力学、时空特征和行走能量成本。
Gait biomechanics, spatial and temporal characteristics, and the energy cost of walking in older adults with impaired mobility.
机构信息
Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA.
出版信息
Phys Ther. 2010 Jul;90(7):977-85. doi: 10.2522/ptj.20090316. Epub 2010 May 20.
BACKGROUND
Abnormalities of gait and changes in posture during walking are more common in older adults than in young adults and may contribute to an increase in the energy expended for walking.
OBJECTIVE
The objective of this study was to examine the contributions of abnormalities of gait biomechanics (hip extension, trunk flexion, and foot-floor angle at heel-strike) and gait characteristics (step width, stance time, and cadence) to the energy cost of walking in older adults with impaired mobility.
DESIGN
A cross-sectional design was used.
METHODS
Gait speed, step width, stance time, and cadence were derived during walking on an instrumented walkway. Trunk flexion, hip extension, and foot-floor angle at heel contact were assessed during overground walking. The energy cost of walking was determined from oxygen consumption data collected during treadmill walking. All measurements were collected at the participants' usual, self-selected walking speed.
RESULTS
Fifty community-dwelling older adults with slow and variable gait participated. Hip extension, trunk flexion, and step width were factors related to the energy cost of walking. Hip extension, step width, and cadence were the only gait measures beyond age and gait speed that provided additional contributions to the variance of the energy cost, with mean R(2) changes of .22, .12, and .07, respectively. Limitations Other factors not investigated in this study (interactions among variables, psychosocial factors, muscle strength [force-generating capacity], range of motion, body composition, and resting metabolic rate) may further explain the greater energy cost of walking in older adults with slow and variable gait.
CONCLUSIONS
Closer inspection of hip extension, step width, and cadence during physical therapy gait assessments may assist physical therapists in recognizing factors that contribute to the greater energy cost of walking in older adults.
背景
与年轻人相比，老年人在行走时步态异常和姿势变化更为常见，这可能导致行走时能量消耗增加。
目的
本研究旨在探讨步态生物力学异常（髋关节伸展、躯干前屈和足跟触地时的足地角度）和步态特征（步宽、站立时间和步频）对活动能力受损的老年人行走能量消耗的贡献。
设计
采用横断面设计。
方法
在步态分析器上行走时，可得出行走速度、步宽、站立时间和步频。在地面行走时，评估躯干前屈、髋关节伸展和足跟触地时的足地角度。从跑步机行走时收集的耗氧量数据确定行走的能量消耗。所有测量均在参与者的常规、自主选择的行走速度下进行。
结果
共有 50 名步态缓慢且不稳定的社区居住老年人参与了本研究。髋关节伸展、躯干前屈和步宽是与行走能量消耗相关的因素。髋关节伸展、步宽和步频是除年龄和行走速度外，对能量消耗方差有额外贡献的唯一步态指标，其平均 R² 变化分别为.22、.12 和.07。局限性 本研究未考察其他因素（变量之间的相互作用、心理社会因素、肌肉力量[产生能力]、活动范围、身体成分和静息代谢率）可能会进一步解释步态缓慢且不稳定的老年人行走能量消耗增加的原因。
结论
在物理治疗步态评估中更仔细地检查髋关节伸展、步宽和步频，可能有助于物理治疗师识别导致老年人行走能量消耗增加的因素。
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