Malcom Randall VA Medical Center, Gainesville, FL 32608-1135, USA.
Neurorehabil Neural Repair. 2013 May;27(4):335-44. doi: 10.1177/1545968312469833. Epub 2013 Jan 4.
Impaired voluntary neuromuscular activation of agonist muscles is a primary determinant of weakness and motor dysfunction following stroke.
To determine whether eccentric resistance training (ECC) resistance training is superior to concentric resistance training (CON) resistance training to enhance neuromuscular activation, strength, and walking speed after stroke.
A total of 34 adults poststroke participated in a staged intervention comprising (1) either CON-only or ECC-only resistance training of the paretic leg followed by (2) gait training. Changes in voluntary neuromuscular activation and power were assessed for both the trained paretic and untrained nonparetic legs. Self-selected and fast walking speeds were also assessed.
In response to resistance training, the ECC group experienced larger improvements in neuromuscular activation of paretic leg muscles, rectus femoris and vastus medialis (P < .005), and the largest gains in paretic leg power (+74% for ECC contractions, P < .0001). ECC also had greater cross-education of increased power to the untrained nonparetic leg (12%-14%, P = .006). Over the course of gait training, much of the gain in paretic leg activation in the ECC group was lost, such that the net change in agonist activation was comparable between the CON and ECC groups when the full intervention was completed. Nevertheless, improvement in walking speed postintervention was more prevalent in the ECC than CON group.
ECC resistance training was more effective for improving bilateral neuromuscular activation, strength, and walking speed following stroke. Future research should assess whether a longer duration ECC training program can provide further benefit.
在脑卒中后，主动肌的神经肌肉激活受损是导致肌肉无力和运动功能障碍的主要原因。
确定离心抗阻训练（ECC）是否优于向心抗阻训练（CON），以增强脑卒中后神经肌肉激活、力量和步行速度。
共有 34 名脑卒中后成年人参与了分阶段干预，包括（1）对患侧肢体进行 CON 或 ECC 单独的抗阻训练，然后（2）进行步态训练。评估了训练和未训练的非患侧肢体的主动肌神经肌肉激活和力量的变化。还评估了自我选择和快速行走速度。
在抗阻训练的反应中，ECC 组在患侧肢体肌肉的神经肌肉激活方面（股直肌和股中间肌）有更大的改善（P<0.005），在患侧肢体力量方面的增益最大（ECC 收缩时增加 74%，P<0.0001）。ECC 对未训练的非患侧肢体的功率交叉教育也有更大的增益（12%-14%，P=0.006）。在步态训练过程中，ECC 组患侧肢体激活的大部分增益都丢失了，因此，当完成完整的干预时，CON 和 ECC 组之间的激活剂激活的净变化是可比的。尽管如此，ECC 组在干预后的步行速度改善更为普遍。
ECC 抗阻训练在脑卒中后更有效地改善双侧神经肌肉激活、力量和步行速度。未来的研究应该评估更长时间的 ECC 训练方案是否能提供进一步的益处。
