Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany.
Institut für Physiotherapie, University Hospital Jena Jena, Germany.
Front Hum Neurosci. 2014 Jun 12;8:416. doi: 10.3389/fnhum.2014.00416. eCollection 2014.
Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy.
Individuals with chronic iSCI had to complete 6 days (1 day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task.
Four of five study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93 ± 1.54 to 2.18 ± 1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40 ± 1.18 to 2.20 ± 0.90). Direct influences of FB ranged from 60 to 15% of reduction in mean ND compared to initial gait analysis and from 20 to 1% compared to no-FB sessions.
Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living.
不完全性脊髓损伤（iSCI）导致运动和感觉功能障碍。即使在运动功能良好的步行者中，本体感觉受损也可能导致步态不稳定。有限的内部传入反馈（FB）可以通过治疗师或技术系统提供外部 FB 来补偿。运动分析系统计算能力的进步使得实施仪器化实时 FB 成为可能。本研究的目的是测试 iSCI 个体是否可以在 FB 期间使他们的步态运动学正常化，更重要的是，在治疗后保持改善。
慢性 iSCI 个体必须完成 6 天（每周 1 天）的跑步机 FB 训练，在 3 天训练后休息 2 周。每天包括初始步态分析，然后进行 2 个 FB/无 FB 块。在 FB 期间，摆动过程中平均膝关节角度与速度匹配参考（标准距离，ND）的偏差显示为数字。任务是降低 ND，每次步幅后更新 ND。在对患者进行测试之前，在健康受试者中使用人工运动任务对内部开发的 FB 实现进行了测试。
5 名研究参与者中有 4 名在短期和中期从 FB 中受益。在最初的 3 个疗程中，平均 ND 的降低幅度最大（从 3.93±1.54 降至 2.18±1.04）。在休息后，平均 ND 保持在与之前相同的范围内。在最后 3 个疗程中，平均 ND 的降低速度较慢（从 2.40±1.18 降至 2.20±0.90）。与初始步态分析相比，FB 的直接影响范围为平均 ND 降低 60%至 15%，与无 FB 相比，FB 的直接影响范围为 20%至 1%。
仪器化运动学实时 FB 可作为不完全性脊髓损伤后使步态模式正常化的有效辅助治疗方法。需要进一步的研究，纳入更大的患者群体，以证明长期学习以及新获得的技能成功转移到日常生活活动中的情况。
