Osada Yuji, Yamamoto Sumiko, Fuchi Masako, Ibayashi Setsuro
Seiai Rehabilitation Hospital.
Graduate School of International University of Health and Welfare.
J Jpn Phys Ther Assoc. 2015;18(1):7-14. doi: 10.1298/jjpta.Vol18_002.
Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task.
Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman's rank correlation coefficient.
The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI.
There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.
一般来说，中风患者能够流畅地行走和站立，但在完成从坐到走（STW）任务时存在困难。本研究的目的是调查STW任务初始接触阶段运动流畅性与运动策略之间的关系。
30名中风患者和10名健康受试者从坐姿开始执行STW任务，其运动由运动分析系统进行测量。使用曼-惠特尼U检验分析患者与健康受试者之间的数据差异。使用斯皮尔曼等级相关系数分析流畅性指数（FI）与其他指标（STW中的动力学和运动学数据、功能独立性测量[FIM]以及Fugl-Meyer评估[FMA]）之间的关系。
中风患者的FI值低于健康受试者，且步长缩短，从开始到第一支撑腿离地的持续时间延长。FI值与初始接触时的躯干弯曲角度、第一步长以及最大垂直地面反作用力相关。爬楼梯和行走能力的FIM独立水平以及平衡的FMA也与FI相关。
平衡能力差有可能是中风患者无法从坐姿流畅开始行走的原因之一。为了流畅地完成STW任务，患者必须在躯干伸展完全完成之前开始行走。FI与身体能力指标（即爬楼梯和平衡）之间的关系可能对指导中风患者进行STW任务具有治疗益处。
