Bryant Mon S, Workman Craig D, Hou Jyh-Gong G, Henson Helene K, York Michele K
Research Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX; Rehabilitation Research (Mail Code 153), 2002 Holcombe Blvd, Houston, TX 77030(∗).
Research Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Health and Human Performance, University of Houston, Houston, TX(†).
PM R. 2016 Dec;8(12):1151-1158. doi: 10.1016/j.pmrj.2016.05.001. Epub 2016 May 10.
Treadmill training has been shown to be a promising rehabilitation strategy for improving gait and balance in persons with Parkinson disease (PD). Most studies have involved only forward walking as an intervention. The effects of multidirectional treadmill (forward, backward, and left and right sideways) on gait and balance have not been reported.
To investigate the acute and long-term effects of multidirectional treadmill training (MDTT) on gait and balance in persons with PD, and to determine the optimal training duration.
Single group, repeated-measures design.
Research laboratory in a hospital.
Ten persons with PD (mean age 65.9 ± 7.4 years; average disease duration 3.90 ± 2.18 years).
MDTT was used. Participants walked forward, backward, and left and right sideways for 5-7 minutes in each direction at their fastest tolerated speed. The training was 3 days per week continuously for 8 weeks.
Gait speed, cadence, and stride length of forward, backward and sideways walks; time and number of steps to turn 360°; and the timed 5-step test and Timed Up-and-Go (TUG) test were performed after the first session of MDTT and every 2 weeks. Effect size of MDTT on each gait and balance variable was measured every 2 weeks for 8 weeks to determine the optimal training duration. Gait and balance variables after the first session of MDTT were compared to the baseline values (pre-MDTT) to study the acute effect of MDTT.
Stride length of forward, backward, and sideways walks improved immediately after 1 session of MDTT (P = .031, .012, and .001, respectively). The number of steps to turn and the timed 5-step test score decreased after the first session (P = .016, and .010, respectively). Six weeks of training was found to yield the largest mean effect size of all gait and balance variables. At 6 weeks of MDTT, gait speed of all walking directions (P = .001-.031), stride length of backward (P < .005) and sideways (P = .001) walks, cadence of sideways walk (P = .036), number of steps to turn (P = .014), and timed 5-step test (P = .033) improved from pre-MDTT measures.
MDTT immediately improved gait and balance in persons with PD. Six weeks of MDTT might be the optimal training duration to improve gait and balance in the long term.
IV.
跑步机训练已被证明是一种有前景的康复策略，可改善帕金森病（PD）患者的步态和平衡能力。大多数研究仅将向前行走作为干预方式。多方向跑步机（向前、向后以及左右侧向）对步态和平衡的影响尚未见报道。
探讨多方向跑步机训练（MDTT）对PD患者步态和平衡的急性及长期影响，并确定最佳训练时长。
单组重复测量设计。
医院的研究实验室。
10名PD患者（平均年龄65.9±7.4岁；平均病程3.90±2.18年）。
采用MDTT。参与者以其能耐受的最快速度在每个方向向前、向后以及左右侧向行走5 - 7分钟。训练每周持续3天，共8周。
向前、向后和侧向行走的步态速度、步频和步幅；转身360°的时间和步数；以及在MDTT第一阶段训练后及之后每2周进行定时5步测试和起立行走测试（TUG）。在8周内每2周测量MDTT对每个步态和平衡变量的效应大小，以确定最佳训练时长。将MDTT第一阶段训练后的步态和平衡变量与基线值（MDTT前）进行比较，以研究MDTT的急性效应。
MDTT训练1次后，向前、向后和侧向行走的步幅立即得到改善（分别为P = 0.031、0.012和0.001）。第一阶段训练后转身步数和定时5步测试得分降低（分别为P = 0.016和0.010）。发现6周训练对所有步态和平衡变量产生的平均效应大小最大。在MDTT训练第6周时，所有行走方向的步态速度（P = 0.001 - 0.031）、向后（P < 0.005）和侧向（P = 0.001）行走的步幅、侧向行走的步频（P = 0.036）、转身步数（P = 0.014）和定时5步测试（P = 0.033）较MDTT训练前均有所改善。
MDTT可立即改善PD患者的步态和平衡。6周的MDTT可能是长期改善步态和平衡的最佳训练时长。
IV级
