Stanhope Victoria A, Knarr Brian A, Reisman Darcy S, Higginson Jill S
Dept. of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA.
Clin Biomech (Bristol). 2014 May;29(5):518-22. doi: 10.1016/j.clinbiomech.2014.03.013. Epub 2014 Apr 13.
Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking.
Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household <0.4m/s, Limited Community 0.4-0.8m/s, Community >0.8m/s).
While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P<.05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction.
These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.
约三分之二的中风患者存在行走障碍。中风后步态中可观察到额状面代偿策略（即骨盆上提和划圈步态），部分原因是为应对膝关节屈曲和踝关节背屈减少而实现足离地。本研究的目的是调查中风后行走时自我选择的步行速度与患侧足离地相关运动学模式之间的关系。
对21名中风患者以自我选择的步行速度进行步态分析。在患侧肢体摆动期计算四个运动学变量：骨盆倾斜峰值（骨盆上提）、髋关节外展峰值（划圈步态）、膝关节屈曲峰值和踝关节背屈峰值。分析患侧关节角度在自我选择的步行速度以及功能相关的行走类别（家庭环境<0.4m/s、有限社区环境0.4 - 0.8m/s、社区环境>0.8m/s）之间的差异。
虽然所有受试者的足离地情况相似，但与步行速度较快者相比，步行速度较慢者的骨盆上提峰值更大，膝关节屈曲、踝关节背屈和划圈步态更小（P<0.05）。此外，四名步行速度最快的受试者通过大量划圈步态来代偿膝关节屈曲和踝关节背屈不足。
这些发现表明，以自我选择的步行速度衡量，中风后步态表现的改善不一定总是通过在所有变量上更接近健康步态的步态模式来实现。似乎快速行走的能力是通过足够的踝关节背屈和膝关节屈曲以实现足离地，或者通过采用划圈步态来克服踝关节背屈或膝关节屈曲不足来实现的
