Genthe Katlin, Schenck Christopher, Eicholtz Steven, Zajac-Cox Laura, Wolf Steven, Kesar Trisha M
a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA.
b Department of Biomedical Engineering , Georgia Institute of Technology , Atlanta , GA , USA.
Top Stroke Rehabil. 2018 Apr;25(3):186-193. doi: 10.1080/10749357.2018.1436384. Epub 2018 Feb 19.
Objectives Gait training interventions that target paretic propulsion induce improvements in walking speed and function in individuals post-stroke. Previously, we demonstrated that able-bodied individuals increase propulsion unilaterally when provided real-time biofeedback targeting anterior ground reaction forces (AGRF). The purpose of this study was to, for the first time, investigate short-term effects of real-time AGRF gait biofeedback training on post-stroke gait. Methods Nine individuals with post-stroke hemiparesis (6 females, age = 54 ± 12.4 years 39.2 ± 24.4 months post-stroke) completed three 6-minute training bouts on an instrumented treadmill. During training, visual and auditory biofeedback were provided to increase paretic AGRF during terminal stance. Gait biomechanics were evaluated before training, and during retention tests conducted 2, 15, and 30 minutes post-training. Primary dependent variables were paretic and non-paretic peak AGRF; secondary variables included paretic and non-paretic peak trailing limb angle, plantarflexor moment, and step length. In addition to evaluating the effects of biofeedback training on these dependent variables, we compared effects of a 6-minute biofeedback training bout to a non-biofeedback control condition. Results Compared to pre-training, significantly greater paretic peak AGRFs were generated during the 2, 15, and 30-minute retention tests conducted after the 18-minute biofeedback training session. Biofeedback training induced no significant effects on the non-paretic leg. Comparison of a 6-minute biofeedback training bout with a speed-matched control bout without biofeedback demonstrated a main effect for training type, with greater peak AGRF generation during biofeedback. Discussion Our results suggest that AGRF biofeedback may be a feasible and promising gait training strategy to target propulsive deficits in individuals post-stroke.
目的 针对偏瘫推进力的步态训练干预可改善中风后个体的步行速度和功能。此前，我们证明，在提供针对前向地面反作用力（AGRF）的实时生物反馈时，健全个体能够单侧增加推进力。本研究的目的是首次调查实时AGRF步态生物反馈训练对中风后步态的短期影响。方法 9名中风后偏瘫患者（6名女性，年龄=54±12.4岁，中风后39.2±24.4个月）在装有仪器的跑步机上完成了3次6分钟的训练回合。在训练过程中，提供视觉和听觉生物反馈，以增加终末支撑期患侧的AGRF。在训练前以及训练后2、15和30分钟进行的保持测试期间评估步态生物力学。主要因变量是患侧和非患侧的AGRF峰值；次要变量包括患侧和非患侧的后肢峰值角度、跖屈力矩和步长。除了评估生物反馈训练对这些因变量的影响外，我们还将6分钟的生物反馈训练回合与无生物反馈的对照条件的效果进行了比较。结果 与训练前相比，在18分钟生物反馈训练课程后的2、15和30分钟保持测试期间，患侧产生的AGRF峰值明显更大。生物反馈训练对非患侧腿没有显著影响。将6分钟的生物反馈训练回合与无生物反馈的速度匹配对照回合进行比较，结果显示训练类型有主要影响，生物反馈期间产生的AGRF峰值更大。讨论 我们的结果表明，AGRF生物反馈可能是一种可行且有前景的步态训练策略，可针对中风后个体的推进力缺陷。
