Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada; Mobility Team, Toronto Rehabilitation Institute, Toronto, ON, Canada.
Gait Posture. 2014 Jan;39(1):177-81. doi: 10.1016/j.gaitpost.2013.06.022. Epub 2013 Jul 19.
Spatial and temporal gait asymmetry is common after stroke. Such asymmetric gait is inefficient, can contribute to instability and may lead to musculoskeletal injury. However, understanding of the determinants of such gait asymmetry remains incomplete. The current study is focused on revealing if there is a link between asymmetry during the control of standing balance and asymmetry during walking. This study involved review of data from 94 individuals with stroke referred to a gait and balance clinic. Participants completed three tests: (1) walking at their usual pace; (2) quiet standing; and (3) standing with maximal loading of the paretic side. A pressure sensitive mat recorded placement and timing of each footfall during walking. Standing tests were completed on two force plates to evaluate symmetry of weight bearing and contribution of each limb to balance control. Multiple regression was conducted to determine the relationships between symmetry during standing and swing time, stance time, and step length symmetry during walking. Symmetry of antero-posterior balance control and weight bearing were related to swing time and step length symmetry during walking. Weight-bearing symmetry, weight-bearing capacity, and symmetry of antero-posterior balance control were related to stance time symmetry. These associations were independent of underlying lower limb impairment. The results support the hypothesis that impaired ability of the paretic limb to control balance may contribute to gait asymmetry post-stroke. Such work suggests that rehabilitation strategies that increase the contribution of the paretic limb to standing balance control may increase symmetry of walking post-stroke.
脑卒中后常出现空间和时间步态不对称。这种不对称步态效率低下，可能导致不稳定，并可能导致肌肉骨骼损伤。然而，对于这种步态不对称的决定因素的理解仍然不完整。本研究旨在揭示站立平衡控制过程中的不对称性与行走过程中的不对称性之间是否存在关联。本研究回顾了 94 名因步态和平衡问题就诊于步态和平衡诊所的脑卒中患者的数据。参与者完成了三项测试：（1）以常规速度行走；（2）安静站立；（3）最大负荷患侧站立。压力敏感垫记录行走过程中每只脚的放置和时间。站立测试在两个测力台上完成，以评估承重对称性和每个肢体对平衡控制的贡献。进行多元回归分析以确定站立时的对称性与行走时的摆动时间、站立时间和步长对称性之间的关系。前后平衡控制的对称性和承重与行走时的摆动时间和步长对称性相关。承重对称性、承重能力和前后平衡控制的对称性与站立时间对称性相关。这些关联独立于下肢潜在的损伤。结果支持这样的假设，即患侧肢体平衡控制能力受损可能导致脑卒中后步态不对称。这种工作表明，增加患侧肢体对站立平衡控制的贡献的康复策略可能会增加脑卒中后行走的对称性。
