Meyns Pieter, Duysens Jacques, Desloovere Kaat
Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium.
Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium; Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, The Netherlands.
Gait Posture. 2016 Sep;49:132-135. doi: 10.1016/j.gaitpost.2016.06.033. Epub 2016 Jun 27.
In this observational case-control study we aimed to determine whether altered arm postures in children with unilateral CP (uniCP) are related to gait instability in a specific direction. Antero-posterior and medio-lateral Foot Placement Estimator instability measures and arm posture measures (vertical and antero-posterior hand position, sagittal and frontal upper arm elevation angle) were determined in eleven uniCP (7 years-10 months) and twenty-four typically developing children (9 years-6 months) at two walking speeds. Spearman-rank correlation analyses were made to examine the relationship between antero-posterior and medio-lateral arm posture and gait instability. Arm posture in both planes was related to antero-posterior instability (e.g. sagittal and frontal upper arm elevation angle correlated moderately with antero-posterior instability; R=0.41, p<0.001, R=-0.47, p<0.001). In uniCP, increased antero-posterior instability was associated with a higher (R=-0.62, p=0.002) and more frontal position of the hemiplegic hand (R=-0.58, p=0.005), while the non-hemiplegic upper arm was rotated more backward (R=0.63, p=0.002) and both upper arms rotated more sideways (hemiplegic: R=-0.58, p=0.004; non-hemiplegic: R=-0.55, p=0.008). The altered non-hemiplegic (sagittal and frontal) arm posture in uniCP may be a compensation to reduce antero-posterior gait instability.
在这项观察性病例对照研究中，我们旨在确定单侧脑瘫（uniCP）儿童的手臂姿势改变是否与特定方向的步态不稳有关。在11名单侧脑瘫儿童（7岁10个月）和24名发育正常儿童（9岁6个月）以两种步行速度行走时，测定前后向和内外侧足部位置估计器的不稳测量值以及手臂姿势测量值（手部垂直和前后位置、矢状面和额状面上臂抬高角度）。进行Spearman等级相关分析以检验前后向和内外侧手臂姿势与步态不稳之间的关系。两个平面上的手臂姿势均与前后向不稳有关（例如，矢状面和额状面上臂抬高角度与前后向不稳呈中度相关；R = 0.41，p < 0.001，R = -0.47，p < 0.001）。在单侧脑瘫儿童中，前后向不稳增加与偏瘫手更高（R = -0.62，p = 0.002）且更靠前的位置有关（R = -0.58，p = 0.005），而非偏瘫上臂向后旋转更多（R = 0.63，p = 0.002），并且两侧上臂向侧面旋转更多（偏瘫侧：R = -0.58，p = 0.004；非偏瘫侧：R = -0.55，p = 0.008）。单侧脑瘫儿童中改变的非偏瘫（矢状面和额状面）手臂姿势可能是为减少前后向步态不稳而进行的一种代偿。
