Awad Louis N, Palmer Jacqueline A, Pohlig Ryan T, Binder-Macleod Stuart A, Reisman Darcy S
Department of Physical Therapy, University of Delaware, Newark, DE, USA Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.
Department of Physical Therapy, University of Delaware, Newark, DE, USA Delaware Clinical and Translational Research Accel Program, University of Delware, Newark, DE, USA.
Neurorehabil Neural Repair. 2015 Jun;29(5):416-23. doi: 10.1177/1545968314552528. Epub 2014 Oct 5.
A higher energy cost of walking poststroke has been linked to reduced walking performance and reduced participation in the community.
To determine the contribution of postintervention improvements in walking speed and spatiotemporal gait asymmetry to the reduction in the energy cost of walking after stroke.
In all, 42 individuals with chronic hemiparesis (>6 months poststroke) were recruited to participate in 12 weeks of walking rehabilitation. The energy cost of walking, walking speed, and step length, swing time, and stance time asymmetries were calculated pretraining and posttraining. Sequential regression analyses tested the cross-sectional (ie, pretraining) and longitudinal (ie, posttraining changes) relationships between the energy cost of walking versus speed and each measure of asymmetry.
Pretraining walking speed (β = -.506) and swing time asymmetry (β = .403) predicted pretraining energy costs: (adj)R(2) = 0.713; F(3, 37) = 34.05; P < .001. In contrast, change in walking speed (β = .340) and change in step length asymmetry (β = .934) predicted change in energy costs with a significant interaction between these independent predictors: (adj)R(2) = 0.699; F(4, 31) = 21.326; P < .001. Moderation by the direction or the magnitude of pretraining asymmetry was not found.
For persons in the chronic phase of stroke recovery, faster and more symmetric walking after intervention appears to be more energetically advantageous than merely walking faster or more symmetrically. This finding has important functional implications, given the relationship between the energy cost of walking and community walking participation.
中风后步行的能量消耗增加与步行能力下降及社区参与度降低有关。
确定中风后干预后步行速度和时空步态不对称性的改善对步行能量消耗降低的贡献。
共招募了42例慢性偏瘫患者（中风后>6个月）参与为期12周的步行康复训练。在训练前和训练后计算步行的能量消耗、步行速度、步长、摆动时间和站立时间不对称性。序列回归分析测试了步行能量消耗与速度以及每种不对称性测量之间的横断面（即训练前）和纵向（即训练后变化）关系。
训练前步行速度（β = -0.506）和摆动时间不对称性（β = 0.403）可预测训练前的能量消耗：（调整后）R² = 0.713；F(3, 37) = 34.05；P < 0.001。相比之下，步行速度的变化（β = 0.340）和步长不对称性的变化（β = 0.934）可预测能量消耗的变化，这些独立预测因素之间存在显著交互作用：（调整后）R² = 0.699；F(4, 31) = 21.326；P < 0.001。未发现训练前不对称性的方向或程度具有调节作用。
对于处于中风恢复慢性期的患者，干预后更快且更对称的步行在能量方面似乎比单纯走得更快或更对称更具优势。鉴于步行能量消耗与社区步行参与之间的关系，这一发现具有重要的功能意义。
