Department of Physical Therapy, University of Delaware, Newark, Delaware, DE 19716 , USA.
Phys Ther. 2011 Mar;91(3):392-403. doi: 10.2522/ptj.20090425. Epub 2011 Jan 20.
Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill.
The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke.
A repeated-measures design was used.
Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured.
Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed. Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking.
Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed.
与患者自感舒适速度的训练相比，快速跑步机训练能更大程度地提高步行速度。目前尚不清楚，在跑步机上进行自我选择速度的训练是否能使步行模式更正常，尽管已有研究表明这种训练方式能改善步行模式。鉴于在跑步机训练中会进行大量的踏步练习，治疗师有必要了解所选择的跑步机速度如何影响在跑步机上练习的步态模式。
本研究旨在描述跑步机速度的系统增加对脑卒中后常见步态偏差的影响。
采用重复测量设计。
20 名脑卒中患者分别以其自感舒适速度、最快速度和两者之间的 2 个速度在跑步机上行走。使用运动捕捉系统测量时空步态参数和运动学步态代偿。
发现患侧和非患侧肢体的步长以及单腿和双腿支撑时间都有显著改善。这些措施的不对称性仅在步长方面有所改善。随着速度的增加，还发现患侧髋关节伸展、拖曳肢体位置和摆动时膝关节屈曲有明显改善。随着速度的增加，没有发现回旋或髋关节抬高的增加。局限性：当将这些结果推广到自我选择步行速度低于 0.4m/s 的脑卒中幸存者时，应谨慎使用。本研究未探讨在地面行走时速度变化的情况。
快速跑步机训练能使脑卒中后的步行模式更正常，而不会同时增加常见的步态代偿，如回旋。在较小的步行速度增加的情况下，可以观察到步态偏差的改善。
