Marrocco Stephanie, Crosby Lucas D, Jones Ian C, Moyer Rebecca F, Birmingham Trevor B, Patterson Kara K
Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
Gait Posture. 2016 Sep;49:297-302. doi: 10.1016/j.gaitpost.2016.07.019. Epub 2016 Jul 19.
Post-stoke gait disorders could cause secondary musculoskeletal complications associated with excessive repetitive loading. The study objectives were to 1) determine the feasibility of measuring common proxies for dynamic medial knee joint loading during gait post-stroke with external knee adduction (KAM) and flexion moments (KFM) and 2) characterize knee loading and typical load-reducing compensations post-stroke.
Participants with stroke (n=9) and healthy individuals (n=17) underwent 3D gait analysis. The stroke and healthy groups were compared with unpaired t-tests on peak KAM and peak KFM and on typical medial knee joint load-reducing compensations; toe out and trunk lean. The relationship between KAM and load-reducing compensations in the stroke group were investigated with Spearman correlations.
Mean (SD) values for KAM and KFM in the healthy group[KAM=2.20 (0.88)%BWht; KFM=0.64 (0.60)%BWht] were not significantly different from the values for the paretic [KAM=2.64 (0.98)%BWht; KFM=1.26 (1.13)%BWht] or non-paretic leg of the stroke group[KAM=2.23(0.62)%BWht; KFM=1.10 (1.20)%BWht]. Post hoc one sample t-tests revealed greater loading in stroke participants on the paretic (n=3), non-paretic (n=1) and both legs (n=2) compared to the healthy group. The angle of trunk lean and the angle of toe out were not related to KAM in the stroke group.
Measurement of limb loading during a gait post-stroke is feasible and revealed excessive loading in individuals with mild to moderate stroke compared to healthy adults. Further investigation of potential joint degeneration and pain due to repetitive excessive loading associated with post-stroke gait is warranted.
中风后步态障碍可导致与过度重复负荷相关的继发性肌肉骨骼并发症。本研究的目的是：1）确定在中风后步态期间通过外部膝关节内收力矩（KAM）和屈曲力矩（KFM）测量动态内侧膝关节负荷常用替代指标的可行性；2）描述中风后膝关节负荷及典型的减轻负荷的代偿情况。
中风患者（n = 9）和健康个体（n = 17）接受三维步态分析。采用非配对t检验比较中风组和健康组的KAM峰值、KFM峰值以及典型的内侧膝关节减轻负荷的代偿情况，即足尖外展和躯干倾斜。采用Spearman相关性分析研究中风组中KAM与减轻负荷代偿之间的关系。
健康组KAM和KFM的均值（标准差）[KAM = 2.20（0.88）%体重×身高；KFM = 0.64（0.60）%体重×身高]与中风组患侧[KAM = 2.64（0.98）%体重×身高；KFM = 1.26（1.13）%体重×身高]或健侧[KAM = 2.23（0.62）%体重×身高；KFM = 1.10（1.20）%体重×身高]相比，差异无统计学意义。事后单样本t检验显示，与健康组相比，中风患者患侧（n = 3）、健侧（n = 1）及双侧（n = 2）的负荷更大。中风组中躯干倾斜角度和足尖外展角度与KAM无关。
中风后步态期间肢体负荷的测量是可行的，且与健康成年人相比，轻度至中度中风患者存在负荷过大的情况。有必要进一步研究与中风后步态相关的重复性过度负荷导致的潜在关节退变和疼痛。
