Biomechanics and Movement Science Program, (D.S.R., M.A.R., K.S.R., J.H., E.H., S.B.M.), Department of Physical Therapy, (D.S.R., R.P., M.A.R., K.S.R., S.B.M.), Department of Mechanical Engineering (J.H.), University of Delaware, Newark, Delaware; and Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia (T.M.K.).
J Neurol Phys Ther. 2013 Dec;37(4):159-65. doi: 10.1097/NPT.0000000000000020.
In rehabilitation, examining how variables change over time can help define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke.
Thirteen persons who were more than 6 months poststroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsiflexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8, and 12 weeks of FastFES locomotor training.
Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion (P < 0.05 for all), and peak paretic trailing limb angle (P < 0.01) improved from pretraining to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pretraining to 4 weeks and from 4 to 12 weeks (P < 0.01 and P < 0.05, respectively for both). Timed Up & Go test time did not improve between pretraining and 4 weeks, but improved by 12 weeks (P = 0.24 and P < 0.01, respectively).
The results demonstrate that walking function improves with a different time course compared with gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the minimally clinically important difference. These findings should be considered when designing locomotor training interventions after stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A63) for more insights from the authors.
在康复中，检查变量随时间的变化情况有助于确定产生所需变化所需的最小训练次数。本研究的目的是确定慢性脑卒中患者步态生物力学和行走功能变化的时间过程。
13 名脑卒中后超过 6 个月的患者参加了 12 周的快速跑步机训练，同时进行足底和背屈肌功能性电刺激（FastFES）。所有参与者在干预开始前、FastFES 运动训练 4、8 和 12 周后都完成了测试。
患肢的峰值肢体推进力、患肢推进积分、患肢峰值膝关节屈曲（所有 P < 0.05）和患肢后跟随肢体角度（所有 P < 0.01）从训练前到 4 周时都有所改善，但在 4 周至 12 周之间没有改善。自我选择的步行速度和 6 分钟步行测试距离从训练前到 4 周以及从 4 周到 12 周都有所改善（两者均 P < 0.01 和 P < 0.05）。计时起立行走测试时间在训练前和 4 周之间没有改善，但在 12 周时有所改善（分别为 P = 0.24 和 P < 0.01）。
结果表明，与步态生物力学相比，慢性脑卒中患者对运动训练干预的反应中，行走功能的改善具有不同的时间过程。需要 36 次训练才能使步行速度的增加超过最小临床重要差异。这些发现应在脑卒中后设计运动训练干预时考虑。
视频摘要（请观看视频，补充数字内容 1，http://links.lww.com/JNPT/A63），以获得作者的更多见解。
