降低中风后的运输成本并增加步行距离:一项关于快速运动训练结合功能性电刺激的随机对照试验。

Reducing The Cost of Transport and Increasing Walking Distance After Stroke: A Randomized Controlled Trial on Fast Locomotor Training Combined With Functional Electrical Stimulation.

作者信息

Awad Louis N, Reisman Darcy S, Pohlig Ryan T, Binder-Macleod Stuart A

机构信息

Harvard University, Cambridge, MA, USA

University of Delaware, Department of Physical Therapy, Newark, DE, USA.

出版信息

Neurorehabil Neural Repair. 2016 Aug;30(7):661-70. doi: 10.1177/1545968315619696. Epub 2015 Nov 30.

Abstract

Background Neurorehabilitation efforts have been limited in their ability to restore walking function after stroke. Recent work has demonstrated proof-of-concept for a functional electrical stimulation (FES)-based combination therapy designed to improve poststroke walking by targeting deficits in paretic propulsion. Objectives To determine the effects on the energy cost of walking (EC) and long-distance walking ability of locomotor training that combines fast walking with FES to the paretic ankle musculature (FastFES). Methods Fifty participants >6 months poststroke were randomized to 12 weeks of gait training at self-selected speeds (SS), fast speeds (Fast), or FastFES. Participants' 6-minute walk test (6MWT) distance and EC at comfortable (EC-CWS) and fast (EC-Fast) walking speeds were measured pretraining, posttraining, and at a 3-month follow-up. A reduction in EC-CWS, independent of changes in speed, was the primary outcome. Group differences in the number of 6MWT responders and moderation by baseline speed were also evaluated. Results When compared with SS and Fast, FastFES produced larger reductions in EC (Ps ≤.03). FastFES produced reductions of 24% and 19% in EC-CWS and EC-Fast (Ps <.001), respectively, whereas neither Fast nor SS influenced EC. Between-group 6MWT differences were not observed; however, 73% of FastFES and 68% of Fast participants were responders, in contrast to 35% of SS participants. Conclusions Combining fast locomotor training with FES is an effective approach to reducing the high EC of persons poststroke. Surprisingly, differences in 6MWT gains were not observed between groups. Closer inspection of the 6MWT and EC relationship and elucidation of how reduced EC may influence walking-related disability is warranted.

摘要

背景

神经康复在中风后恢复步行功能方面的能力一直有限。最近的研究已证明了一种基于功能性电刺激(FES)的联合疗法的概念验证,该疗法旨在通过针对患侧推进力缺陷来改善中风后的步行能力。目的:确定将快速步行与对患侧踝关节肌肉进行FES相结合的运动训练(FastFES)对步行能量消耗(EC)和长距离步行能力的影响。方法:50名中风后6个月以上的参与者被随机分为三组,分别进行为期12周的自我选择速度(SS)、快速速度(Fast)或FastFES步态训练。在训练前、训练后和3个月随访时,测量参与者在舒适步行速度(EC-CWS)和快速步行速度(EC-Fast)下的6分钟步行试验(6MWT)距离和EC。主要结果是EC-CWS的降低,且与速度变化无关。还评估了6MWT反应者数量的组间差异以及基线速度的调节作用。结果:与SS和Fast相比,FastFES使EC降低幅度更大(P≤0.03)。FastFES使EC-CWS和EC-Fast分别降低了24%和19%(P<0.001),而Fast和SS均未影响EC。未观察到组间6MWT的差异;然而,FastFES组73%的参与者和Fast组68%的参与者是反应者,而SS组只有35%的参与者是反应者。结论:将快速运动训练与FES相结合是降低中风后患者高EC的有效方法。令人惊讶的是,未观察到组间6MWT增加的差异。有必要更仔细地研究6MWT与EC的关系,并阐明EC降低如何影响与步行相关的残疾。

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