Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Physiotherapy Department, Austin Health, Heidelberg West, Victoria, Australia.
Gait Posture. 2014 Jan;39(1):213-7. doi: 10.1016/j.gaitpost.2013.07.008. Epub 2013 Aug 2.
While it is well established that obstacle crossing is impaired following stroke, it is not known whether obstacle crossing improves as gait improves following stroke. The purpose of this study was to determine whether obstacle crossing changed over a one month time period in people with a recent stroke. Twenty participants receiving rehabilitation following a recent stroke were tested on two occasions one month apart. Participants received usual care rehabilitation, including physiotherapy, between the tests. The main outcome measure was obstacle crossing speed as participants stepped over a 4-cm high obstacle. Secondary measures were spatiotemporal variables. Data were collected via a three dimensional motion analysis system. When leading with the affected limb no changes in obstacle crossing speed or spatiotemporal variables were observed over the one month period. When leading with the unaffected limb, crossing speed significantly increased (p=.002), and affected trail limb swing time (p=.03) and crossing step double support time reduced (p=.016). While not significant, the lead and trail limb pre-obstacle distance increased (p=.08), and lead swing time (p=.052) reduced. Change in obstacle crossing speed did not correlate with change in level gait speed. Obstacle crossing does not necessarily improve over a one month time period in people receiving rehabilitation following stroke. These findings suggest that there may be a need for more targeted training of obstacle crossing, particularly when leading with the affected limb.
虽然已经明确指出，中风后越过障碍物的能力会受损，但尚不清楚中风后步态改善是否会导致障碍物的跨越能力提高。本研究的目的是确定在最近发生中风的人群中，跨越障碍物的能力是否会在一个月的时间内发生变化。20 名在最近发生中风后接受康复治疗的参与者在相隔一个月的两次测试中接受了测试。参与者在两次测试之间接受了常规的康复治疗，包括物理治疗。主要的结果测量是参与者跨过 4 厘米高的障碍物时的跨越速度。次要的测量指标是时空变量。数据通过三维运动分析系统收集。当用患侧肢体领先时，跨越障碍物的速度或时空变量在一个月内没有变化。当用非患侧肢体领先时，跨越速度显著增加（p=.002），并且患侧尾随肢体摆动时间（p=.03）和跨越步双支撑时间减少（p=.016）。虽然不显著，但主导和尾随肢体的障碍物前距离增加（p=.08），而主导摆动时间（p=.052）减少。跨越障碍物速度的变化与步行速度的变化没有相关性。在接受中风后康复治疗的人群中，跨越障碍物的能力不一定会在一个月的时间内得到改善。这些发现表明，可能需要对跨越障碍物进行更有针对性的训练，特别是当用患侧肢体领先时。
