From the Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina (ECW, MGB); Division of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina (ELM, KLH, SEF, MGB); and Ralph H. Johnson VA Medical Center, Charleston, South Carolina (MGB).
Am J Phys Med Rehabil. 2018 Feb;97(2):131-133. doi: 10.1097/PHM.0000000000000840.
Kinematic and kinetic outcome measures are tightly linked in walking. Although altering motor output is a major goal of gait rehabilitation, little is understood regarding the relationship between altering a single kinematic variable and kinetic outcome changes. We designed a strategy to isolate hip extension alterations during walking on a treadmill to assess the change in kinetic outcomes. Ten healthy individuals walked on an instrumented split-belt treadmill with motion capture to calculate hip extension and kinetic outcomes at the following five different randomized cadences: self-selected cadence, self-selected ± 10%, and self-selected ± 20%. The treadmill speed was held constant at the individual's self-selected walking speed, forcing cadence changes to result in successful alterations to hip extension, varying 8.3 degrees from the self-selected -20% to +20% cadence conditions. Kinetic outcomes demonstrated similar alterations. Hip extension changes at each cadence significantly correlated with kinetic changes in propulsive impulse (r = 0.852, P < 0.001), peak ankle power (r = 0.473, P = 0.002), and ankle plantarflexion work (r = 0.762, P < 0.001). These results demonstrate that kinetic outcomes are highly alterable in response to a kinematic gait change. This clinically relevant finding highlights the potential to improve motor output in individuals during rehabilitation by altering gait patterns to achieve more optimal limb positions.
运动学和动力学测量结果在行走中紧密相关。虽然改变运动输出是步态康复的主要目标,但对于改变单个运动学变量与动力学结果变化之间的关系,我们知之甚少。我们设计了一种策略,在跑步机上行走时隔离髋关节伸展的改变,以评估动力学结果的变化。10 名健康个体在配备运动捕捉的仪器化分带跑步机上行走,以计算以下五种不同随机步速的髋关节伸展和动力学结果:自我选择的步速、自我选择的±10%和自我选择的±20%。跑步机速度保持在个体的自我选择行走速度,迫使步速变化导致髋关节伸展成功改变,从自我选择的-20%到+20%步速条件下,髋关节伸展变化 8.3 度。动力学结果显示出相似的改变。每个步速的髋关节伸展变化与推进冲量(r=0.852,P<0.001)、峰值踝关节功率(r=0.473,P=0.002)和踝关节跖屈功(r=0.762,P<0.001)的变化显著相关。这些结果表明,动力学结果在响应运动学步态变化时具有高度可变性。这一具有临床意义的发现强调了通过改变步态模式来实现更理想的肢体位置,从而在康复期间改善个体运动输出的潜力。