1] Department of Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark [2] Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark [3] School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada.
Spinal Cord. 2013 Nov;51(11):852-6. doi: 10.1038/sc.2013.84. Epub 2013 Aug 13.
Maximum toe elevation during walking is an objective measure of foot drop and reflects the impairment of the corticospinal tract (CST) in persons with spinal cord injury (SCI). To determine if this measurement is functionally relevant to ambulatory abilities, we correlated maximum toe elevation with clinical physiotherapy tests.
Cross-sectional study, laboratory and clinical settings.
A total of 24 individuals with SCI (American Spinal Injury Association (ASIA) Impairment Scale D) were recruited. Maximum toe elevation during the swing phase of treadmill gait was measured with a kinematic system. CST function was assessed in a sitting position by measuring the motor-evoked potentials (MEPs) induced in tibialis anterior muscle with transcranial magnetic stimulation over the motor cortex. Clinical tests performed were 10-m and 6-min walk test (6MWT), Timed-Up and Go (TUG), Walking Index for Spinal Cord Injury, Berg Balance Scale, Lower Extremity Motor Score (LEMS) and sensory score of the L4, L5 and S1 dermatomes.
Participants with lower toe elevation during gait walked at a slower speed, took more time to perform the TUG test, and covered a shorter distance in the 6MWT. They also scored lower on the LEMS and showed impaired superficial sensitivity of the dermatomes around the ankles. Few correlations were observed between CST function and clinical tests, but the presence of MEP at rest was indicative of faster speed and longer distance in the 6MWT.
These results indicate that maximum toe elevation, which is directly correlated with CST impairment, is functionally relevant as it also correlates with timed clinical tests, LEMS and sensory scores.
行走时最大脚趾抬高是足下垂的客观测量指标，反映了脊髓损伤（SCI）患者皮质脊髓束（CST）的损伤。为了确定该测量值与步行能力是否具有功能相关性，我们将最大脚趾抬高与临床物理治疗测试进行了相关性分析。
横断面研究，实验室和临床环境。
共招募了 24 名 SCI 患者（美国脊髓损伤协会（ASIA）损伤量表 D 级）。使用运动学系统测量跑步机步态摆动相期间的最大脚趾抬高。通过经颅磁刺激在运动皮质上刺激胫骨前肌来测量运动诱发电位（MEPs），在坐姿下评估 CST 功能。进行的临床测试包括 10 米和 6 分钟步行测试（6MWT）、计时起立行走测试（TUG）、脊髓损伤步行指数、Berg 平衡量表、下肢运动评分（LEMS）和 L4、L5 和 S1 皮节的感觉评分。
步态中脚趾抬高较低的参与者行走速度较慢，TUG 测试用时更长，6MWT 中行走距离更短。他们的 LEMS 评分也较低，踝关节周围皮节的浅表感觉受损。CST 功能与临床测试之间观察到的相关性较少，但静息时存在 MEP 提示 6MWT 中速度更快、距离更长。
这些结果表明，与 CST 损伤直接相关的最大脚趾抬高在功能上是相关的，因为它还与计时临床测试、LEMS 和感觉评分相关。
