Kamono Arinori, Ogihara Naomichi
1 School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan.
2 Faculty of Science and Technology, Keio University, Yokohama, Japan.
Proc Inst Mech Eng H. 2018 Apr;232(4):361-370. doi: 10.1177/0954411918757814. Epub 2018 Feb 15.
The ability to shift weight toward the paretic leg has been considered an essential ability to restore independent walking for post-acute stroke patients. However, few data are available regarding the relationship between the weight-shift ability and gait performance. No clear mechanism has been provided as to why and how the weight-shift ability improves walking performance in stroke patients. We therefore investigated changes in the weight-shift ability and kinematic and kinetic parameters of walking gait in post-stroke patients during rehabilitation. Eight male inpatients undergoing rehabilitation for moderate hemiplegia participated in this study. Measurements were taken every 4 weeks from when the participants were able to walk at least 10 m until they were discharged from the hospital. Our results demonstrated a significant overall correlation between the weight-shift ability and walking velocity, indicating that the improvement in the weight-shift ability toward the paretic leg by lateral tilting of the thorax is fundamentally important to improve walking velocity. We also found that the upward impulse and vertical ground reaction force exerted by the paretic leg were significantly correlated with the walking velocity to cope with the downward impulse due to gravity and to allow sufficient time to swing the non-paretic leg forward during walking. Therefore, improvement in the weight-shift ability is crucial for restoration of walking velocity. We believe that weight-shift training for the paretic leg while instructing the patients to laterally tilt the thorax should be advocated as an effective protocol during rehabilitation of post-acute stroke inpatients.
将体重转移到患侧腿上的能力被认为是急性脑卒中后患者恢复独立行走的一项基本能力。然而，关于体重转移能力与步态表现之间的关系，目前可用的数据很少。对于体重转移能力为何以及如何改善脑卒中患者的行走表现，尚未有明确的机制。因此，我们研究了脑卒中后患者在康复过程中体重转移能力以及步行步态的运动学和动力学参数的变化。八名因中度偏瘫接受康复治疗的男性住院患者参与了本研究。从参与者能够行走至少10米开始，每4周进行一次测量，直至他们出院。我们的结果表明，体重转移能力与步行速度之间存在显著的总体相关性，这表明通过胸部侧向倾斜向患侧腿转移体重能力的改善对于提高步行速度至关重要。我们还发现，患侧腿施加的向上冲量和垂直地面反作用力与步行速度显著相关，以应对重力引起的向下冲量，并在行走过程中为摆动非患侧腿向前留出足够的时间。因此，体重转移能力的改善对于恢复步行速度至关重要。我们认为，在急性脑卒中后住院患者的康复过程中，应提倡对患侧腿进行体重转移训练，同时指导患者胸部侧向倾斜，这是一种有效的方案。
