MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, the Netherlands.
Phys Ther. 2012 Nov;92(11):1452-60. doi: 10.2522/ptj.20110362. Epub 2012 Jul 26.
Gait adaptability, including the ability to avoid obstacles and to take visually guided steps, is essential for safe movement through a cluttered world. This aspect of walking ability is important for regaining independent mobility but is difficult to assess in clinical practice.
The objective of this study was to investigate the validity of an instrumented treadmill with obstacles and stepping targets projected on the belt's surface for assessing prosthetic gait adaptability.
This was an observational study.
A control group of people who were able bodied (n=12) and groups of people with transtibial (n=12) and transfemoral (n=12) amputations participated. Participants walked at a self-selected speed on an instrumented treadmill with projected visual obstacles and stepping targets. Gait adaptability was evaluated in terms of anticipatory and reactive obstacle avoidance performance (for obstacles presented 4 steps and 1 step ahead, respectively) and accuracy of stepping on regular and irregular patterns of stepping targets. In addition, several clinical tests were administered, including timed walking tests and reports of incidence of falls and fear of falling.
Obstacle avoidance performance and stepping accuracy were significantly lower in the groups with amputations than in the control group. Anticipatory obstacle avoidance performance was moderately correlated with timed walking test scores. Reactive obstacle avoidance performance and stepping accuracy performance were not related to timed walking tests. Gait adaptability scores did not differ in groups stratified by incidence of falls or fear of falling.
Because gait adaptability was affected by walking speed, differences in self-selected walking speed may have diminished differences in gait adaptability between groups.
Gait adaptability can be validly assessed by use of an instrumented treadmill with a projected visual context. When walking speed is taken into account, this assessment provides unique, quantitative information about walking ability in people with a lower-limb amputation.
步态适应性，包括避免障碍物和根据视觉引导进行迈步的能力，对于在杂乱的环境中安全移动至关重要。这种行走能力对于恢复独立行动能力很重要，但在临床实践中难以评估。
本研究旨在探讨在带表面投影障碍物和踏点的仪器化跑步机上评估假肢步态适应性的有效性。
这是一项观察性研究。
研究纳入了一组健康人（n=12）和一组小腿截肢者（n=12）和大腿截肢者（n=12）。参与者以自我选择的速度在带表面投影视觉障碍物和踏点的仪器化跑步机上行走。步态适应性通过预测性和反应性障碍物回避性能（分别针对提前 4 步和 1 步呈现的障碍物）以及在规则和不规则踏点模式上的踏准精度来评估。此外，还进行了几项临床测试，包括计时步行测试和跌倒发生率和跌倒恐惧的报告。
与对照组相比，截肢组的障碍物回避性能和踏准精度明显较低。预测性障碍物回避性能与计时步行测试评分中度相关。反应性障碍物回避性能和踏准精度与计时步行测试无关。按跌倒发生率或跌倒恐惧分层的组之间，步态适应性评分没有差异。
由于步态适应性受步行速度的影响，组间步行速度的差异可能会降低步态适应性的差异。
使用带投影视觉环境的仪器化跑步机可以有效地评估步态适应性。当考虑步行速度时，这种评估可以提供有关下肢截肢者行走能力的独特、定量信息。
