Leech Kristan A, Kinnaird Catherine R, Holleran Carey L, Kahn Jennifer, Hornby T George
K.A. Leech, PT, DPT, PhD, Interdepartmental Neuroscience Program, Northwestern University, Chicago, Illinois, and Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois.
C.R. Kinnaird, ME, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
Phys Ther. 2016 Dec;96(12):1919-1929. doi: 10.2522/ptj.20150646. Epub 2016 Jun 16.
High-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.
The purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.
A single-day, repeated-measures, pretraining-posttraining study design was used.
Nineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.
The results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.
Measures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.
High-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.
高强度步行训练可能是改善运动不完全性脊髓损伤（iSCI）后步态的关键组成部分。然而，传统康复理论不鼓励这种训练，认为高强度运动训练会降低步态表现。因此，尽管支持这一观点的证据有限，但这种训练被认为会强化异常运动模式。
本研究的目的是：（1）评估短期调节运动强度对iSCI患者步态表现的影响，以及（2）评估高强度运动训练对步行表现的潜在有害影响。
采用单日、重复测量、训练前-训练后研究设计。
19名慢性iSCI患者进行了分级强度的运动训练任务，同时收集下肢运动学和肌电图数据。在峰值步态速度的33%、67%和100%的强度水平上比较感兴趣的指标。9名患者的子集参加了为期12周的高强度运动训练。在训练前和训练后评估之间收集并比较类似的测量数据。
结果表明，强度的短期增加导致肌肉活动、时空指标和关节活动度显著改善，运动协调测量指标也有特定改善。高强度运动训练导致峰值步态速度显著增加（从0.64米/秒提高到0.80米/秒），时空和运动学指标显示协调能力有改善趋势。
步态表现的测量是在跑步机行走过程中进行的，未与对照组进行比较。这些结果对地面行走的可推广性尚不清楚。
高强度运动训练不会降低，反而会改善iSCI患者的运动功能和质量，这与神经损伤后运动功能障碍的传统理论相反。
