Reissman Megan E, Gordon Keith E, Dhaher Yasin Y
Department of Mechanical Engineering, University of Dayton, Dayton, OH, United States.
Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Edward Hines Jr. VA Hospital, Hines, IL, United States.
J Biomech. 2018 Jan 23;67:129-136. doi: 10.1016/j.jbiomech.2017.11.031. Epub 2017 Dec 6.
Post-stroke individuals often exhibit abnormal kinematics, including increased pelvic obliquity and hip abduction coupled with reduced knee flexion. Prior examinations suggest these behaviors are expressions of abnormal cross-planar coupling of muscle activity. However, few studies have detailed the impact of gait-retraining paradigms on three-dimensional joint kinematics. In this study, a cross-tilt walking surface was examined as a novel gait-retraining construct. We hypothesized that relative to baseline walking kinematics, exposure to cross-tilt would generate significant changes in subsequent flat-walking joint kinematics during affected limb swing. Twelve post-stroke participants walked on a motorized treadmill platform during a flat-walking condition and during a 10-degree cross-tilt with affected limb up-slope, increasing toe clearance demand. Individuals completed 15 min of cross-tilt walking with intermittent flat-walking catch trials and a final washout period (5 min). For flat-walking conditions, we examined changes in pelvic obliquity, hip abduction/adduction and knee flexion kinematics at the spatiotemporal events of swing initiation and toe-off, and the kinematic event of maximum angle during swing. Pelvic obliquity significantly reduced at swing initiation and maximum obliquity in the final catch trial and late washout. Knee flexion significantly increased at swing initiation, toe-off, and maximum flexion across catch trials and late washout. Hip abduction/adduction was not significantly influenced following cross-tilt walking. Significant decrease in the rectus femoris and medial hamstrings muscle activity across catch trials and late washout was observed. Exploiting the abnormal features of post-stroke gait during retraining yielded desirable changes in muscular and kinematic patterns post-training.
中风后的个体通常表现出异常的运动学特征，包括骨盆倾斜增加、髋关节外展以及膝关节屈曲减少。先前的检查表明，这些行为是肌肉活动异常的跨平面耦合的表现。然而，很少有研究详细阐述步态再训练模式对三维关节运动学的影响。在本研究中，我们研究了交叉倾斜行走表面作为一种新型的步态再训练结构。我们假设，相对于基线行走运动学，暴露于交叉倾斜会在患侧肢体摆动期间的后续平地行走关节运动学中产生显著变化。12名中风后参与者在电动跑步机平台上进行平地行走和患侧肢体上坡的10度交叉倾斜行走，增加了离地间隙需求。个体完成了15分钟的交叉倾斜行走，并进行了间歇性的平地行走捕捉试验和最后的洗脱期（5分钟）。对于平地行走条件，我们检查了摆动起始和离地时的时空事件以及摆动期间最大角度的运动学事件时骨盆倾斜、髋关节外展/内收和膝关节屈曲运动学的变化。在摆动起始时骨盆倾斜显著降低，在最后的捕捉试验和晚期洗脱期最大倾斜度也显著降低。在摆动起始、离地以及整个捕捉试验和晚期洗脱期的最大屈曲时，膝关节屈曲显著增加。交叉倾斜行走后髋关节外展/内收没有受到显著影响。在整个捕捉试验和晚期洗脱期观察到股直肌和内侧腘绳肌的肌肉活动显著降低。在再训练期间利用中风后步态的异常特征在训练后产生了理想的肌肉和运动学模式变化。
