Dipaola Mariangela, Pavan Esteban E, Cattaneo Andrea, Frazzitta Giuseppe, Pezzoli Gianni, Cavallari Paolo, Frigo Carlo A, Isaias Ioannis U
Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, Milan, Italy.
Movement Biomechanics and Motor Control Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
PLoS One. 2016 Jun 3;11(6):e0156420. doi: 10.1371/journal.pone.0156420. eCollection 2016.
The mechanisms of mechanical energy recovery during gait have been thoroughly investigated in healthy subjects, but never described in patients with Parkinson disease (PD). The aim of this study was to investigate whether such mechanisms are preserved in PD patients despite an altered pattern of locomotion. We consecutively enrolled 23 PD patients (mean age 64±9 years) with bilateral symptoms (H&Y ≥II) if able to walk unassisted in medication-off condition (overnight suspension of all dopaminergic drugs). Ten healthy subjects (mean age 62±3 years) walked both at their 'preferred' and 'slow' speeds, to match the whole range of PD velocities. Kinematic data were recorded by means of an optoelectronic motion analyzer. For each stride we computed spatio-temporal parameters, time-course and range of motion (ROM) of hip, knee and ankle joint angles. We also measured kinetic (Wk), potential (Wp), total (WtotCM) energy variations and the energy recovery index (ER). Along with PD progression, we found a significant correlation of WtotCM and Wp with knee ROM and in particular with knee extension in terminal stance phase. Wk and ER were instead mainly related to gait velocity. In PD subjects, the reduction of knee ROM significantly diminished both Wp and WtotCM. Rehabilitation treatments should possibly integrate passive and active mobilization of knee to prevent a reduction of gait-related energetic components.
健康受试者步态中机械能恢复的机制已得到充分研究，但帕金森病（PD）患者的此类机制从未被描述过。本研究的目的是调查尽管运动模式改变，但PD患者是否仍保留这些机制。我们连续纳入了23名双侧有症状（H&Y≥II）的PD患者（平均年龄64±9岁），前提是他们在停药状态（所有多巴胺能药物夜间停用）下能够独立行走。10名健康受试者（平均年龄62±3岁）以他们的“偏好”和“缓慢”速度行走，以匹配PD患者的整个速度范围。通过光电运动分析仪记录运动学数据。对于每一步，我们计算时空参数、髋、膝和踝关节角度的时间进程和运动范围（ROM）。我们还测量了动能（Wk）、势能（Wp）、总能量变化（WtotCM）和能量恢复指数（ER）。随着PD病情进展，我们发现WtotCM和Wp与膝关节ROM显著相关，尤其是在终末站立期与膝关节伸展显著相关。相反，Wk和ER主要与步态速度有关。在PD患者中，膝关节ROM的减少显著降低了Wp和WtotCM。康复治疗可能应结合膝关节的被动和主动活动，以防止与步态相关的能量成分减少。
