Waters R L, Yakura J S, Adkins R, Barnes G
Department of Orthopedic Surgery, University of Southern California, Downey.
Arch Phys Med Rehabil. 1989 Nov;70(12):811-8.
Measurement of lower extremity muscle strength and the energy expenditure during walking was taken in 36 spinal cord injury patients to assess functional mobility. Patients were categorized according to the type of orthotic prescription (knee-ankle-foot orthosis [KAFO] or ankle-foot orthosis [AFO]) or upper extremity assistive device (cane, crutches, or walker) used during gait. The rates of O2 consumption per minute, O2 cost per meter, heart rate, respiratory quotient, velocity, cadence, and peak axial load exerted by the arms on upper extremity assistive devices were measured. The Ambulatory Motor Index (AMI), derived from the manual muscle grades of both lower limbs, was used as the indicator of the degree of paralysis. The AMI was strongly correlated with the percentage increase in the rate of O2 consumption above normal (p less than .0001), O2 cost per meter (p less than .0001), peak axial load (p less than .0001), velocity (p less than .0001), and cadence (p less than .0001). Differences in these parameters among patient groups categorized according to the type of orthotic prescription (no KAFO, one KAFO, two KAFOs) or upper extremity assistive device (no device, cane or one crutch, two crutches, or walker) were attributable to differences in the AMI. The AMI, therefore, could be used as a reliable clinical indicator of functional mobility after spinal cord injury.
对36名脊髓损伤患者进行了下肢肌肉力量和步行时能量消耗的测量，以评估功能活动能力。患者根据步态时使用的矫形器处方类型（膝踝足矫形器[KAFO]或踝足矫形器[AFO]）或上肢辅助装置（手杖、拐杖或助行器）进行分类。测量了每分钟耗氧量、每米耗氧量、心率、呼吸商、速度、步频以及手臂在上肢辅助装置上施加的峰值轴向负荷。由双下肢徒手肌力分级得出的动态运动指数（AMI）被用作瘫痪程度的指标。AMI与高于正常水平的耗氧率增加百分比（p小于0.0001）、每米耗氧量（p小于0.0001）、峰值轴向负荷（p小于0.0001）、速度（p小于0.0001）和步频（p小于0.0001）密切相关。根据矫形器处方类型（无KAFO、一个KAFO、两个KAFO）或上肢辅助装置（无装置、手杖或一根拐杖、两根拐杖或助行器）分类的患者组之间，这些参数的差异归因于AMI的差异。因此，AMI可作为脊髓损伤后功能活动能力的可靠临床指标。
