Kesar Trisha M, Sauer Michelle J, Binder-Macleod Stuart A, Reisman Darcy S
Physical Therapy Division, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia (T.M.K., M.J.S.); and Department of Physical Therapy, University of Delaware, Newark, Delaware (S.A.B-M., D.S.R.).
J Neurol Phys Ther. 2014 Jul;38(3):183-9. doi: 10.1097/NPT.0000000000000047.
To develop more effective gait rehabilitation strategies, it is important to understand the time course of motor learning that underlies improvements achieved with gait training. The purpose of this case study was to evaluate motor learning through the measurement of within-session and across-session changes in gait biomechanics during the first and sixth weeks of a 6-week clinical gait training program.
A 47-year-old man with poststroke left hemiparesis participated in the study (15.5 months poststroke, lower extremity Fugl-Meyer score of 12).
The subject participated in 6 weeks of training with 3 sessions per week, comprising fast treadmill walking and functional electrical stimulation to plantar and dorsiflexors. In one training session during the first and sixth weeks, paretic propulsion and swing phase knee flexion were measured during a pretest (before the training session), posttest (after the training session), and retention test (48 hours after training).
After 6 week of training, the subject's gait speed increased from 0.38 to 0.57 m/s; there was a 55.4% improvement in paretic propulsion and 25% increase in swing phase knee flexion. Examination of change scores revealed greater within-session gains and greater retention during the first versus sixth weeks of gait training for both paretic propulsion and knee flexion.
We demonstrate the feasibility and advantage of using within- and across-session changes for evaluating motor learning during clinical gait rehabilitation. An understanding of the time course of motor learning that underlies gait training can guide the development of novel strategies and dosing regimens to increase the efficacy of each session of gait rehabilitation.
(See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A72, for more insights from the authors.).
为了制定更有效的步态康复策略，了解步态训练取得改善背后的运动学习时间进程很重要。本案例研究的目的是通过测量为期6周的临床步态训练计划第一周和第六周内步态生物力学的 session 内变化和跨 session 变化来评估运动学习。
一名47岁的中风后左侧偏瘫男性参与了该研究（中风后15.5个月，下肢Fugl-Meyer评分为12）。
受试者参加了为期6周的训练，每周3次，包括在跑步机上快速行走以及对足底和背屈肌进行功能性电刺激。在第一周和第六周的一次训练中，在预测试（训练前）、后测试（训练后）和保留测试（训练后48小时）期间测量患侧推进力和摆动相膝关节屈曲。
经过6周的训练，受试者的步态速度从0.38米/秒提高到0.57米/秒；患侧推进力提高了55.4%，摆动相膝关节屈曲增加了25%。对变化分数的检查显示，在步态训练的第一周与第六周，患侧推进力和膝关节屈曲在 session 内的改善更大且保留率更高。
我们证明了在临床步态康复期间使用 session 内和跨 session 变化来评估运动学习的可行性和优势。了解步态训练背后的运动学习时间进程可以指导制定新的策略和给药方案，以提高每次步态康复训练的效果。
（见视频，补充数字内容1，http://links.lww.com/JNPT/A72，获取作者更多见解。）
