Kim Woo-Sub, Kim Min Joo
a Department of Physical Medicine and Rehabilitation , Korea University Guro Hospital , Seoul , South Korea.
b Department of Rehabilitation Medicine , Veterans Health Service Medical Center , Seoul Veteran Hospital, Seoul , South Korea.
Top Stroke Rehabil. 2017 Apr;24(3):170-176. doi: 10.1080/10749357.2016.1219128. Epub 2016 Aug 12.
Patients with post-stroke hemiplegia have difficulty with body weight support during walking. However, it is unclear which intra-limb strategy for body weight support tends to predominate, and how the intra-limb strategy is related to gait function. Support moment and individual joint contribution to support moment are the parameters that reflect intra-limb strategy for body weight supporting. The aim of this study was to test whether support moment and individual joint contributions differed between post-stroke subjects with different gait function.
Laboratory gait analysis was performed for 14 non-hemiplegic elderly (NE) and 12 post-stroke hemiplegic elderly walking without cane (HNC) and 11 walking with a cane (HWC). Data were obtained for the vertical ground reaction force (vGRF) curve, 1st peak and 2nd peak of vGRF and corresponding temporal occurrences. Support moment (Ms) was numerical sum of hip extension, knee extension, and ankle plantar flexion moment. Individual joint contribution was calculated as the ratio of each joint moment to support moment. At temporal occurrences of vGRF peaks, Ms and individual joint contribution to Ms were calculated. Ms and individual joint contribution to Ms were compared among NE, HNC and HWC groups. Each subject's characteristics of individual joint contribution to Ms were explored.
At the 1st peak of vGRF, support moments were similar among the three groups. However, the hip contributions were significantly greater in the NE group than in the other two groups, the ankle contributions were significantly greater in the HNC group than in the NE group. Notably, some of the subjects with post-stroke hemiplegia showed atypical characteristics that did not correspond to the group characteristics.
Observing support moment and individual joint contribution is helpful to ascertain not only group characteristics, but also individual characteristics of intra-limb strategy for weight support in patients with post-stroke hemiplegia.
中风后偏瘫患者在行走时难以支撑体重。然而，尚不清楚哪种肢体内部的体重支撑策略占主导地位，以及肢体内部策略与步态功能之间的关系。支撑力矩和各个关节对支撑力矩的贡献是反映肢体内部体重支撑策略的参数。本研究的目的是测试不同步态功能的中风后受试者之间的支撑力矩和各个关节的贡献是否存在差异。
对14名非偏瘫老年人（NE）、12名不使用拐杖行走的中风后偏瘫老年人（HNC）和11名使用拐杖行走的中风后偏瘫老年人（HWC）进行实验室步态分析。获取垂直地面反作用力（vGRF）曲线、vGRF的第一峰值和第二峰值以及相应的时间点数据。支撑力矩（Ms）是髋关节伸展、膝关节伸展和踝关节跖屈力矩的数值总和。各个关节的贡献计算为每个关节力矩与支撑力矩的比值。在vGRF峰值的时间点，计算Ms和各个关节对Ms的贡献。比较NE、HNC和HWC组之间的Ms和各个关节对Ms的贡献。探索每个受试者各个关节对Ms贡献的特征。
在vGRF的第一峰值时，三组之间的支撑力矩相似。然而，NE组的髋关节贡献明显大于其他两组，HNC组的踝关节贡献明显大于NE组。值得注意的是，一些中风后偏瘫患者表现出与组特征不符的非典型特征。
观察支撑力矩和各个关节的贡献不仅有助于确定中风后偏瘫患者体重支撑的肢体内部策略的组特征，还有助于确定个体特征。
