Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.
Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.
J Neuroeng Rehabil. 2018 Sep 17;15(1):82. doi: 10.1186/s12984-018-0426-3.
Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. Conventional physiotherapy can be complemented with robot-assisted gait therapy (RAGT) and exergames to enhance the number of step repetitions, feedback, motivation, and additional simultaneously performed tasks besides walking (e.g., dual-task (DT) activities). Although DT gait training leads to improvements in daily ambulation in adult patient groups, no study has evaluated RAGT with a DT exergame in children with neurological gait disorders. Therefore, we investigated children's functional and cognitive prerequisites to walk physiologically during RAGT with a DT exergame and analysed the influence of DT on leg muscle activity.
Children and adolescents (6-18 years) with neurological gait disorders completed RAGT with and without a DT exergame in this quasi-experimental study. We assessed several measures on the body function and activity domains (according to the International Classification of Functioning, Disability, and Health (ICF)) and determined whether these measures could distinguish well between children who walked physiologically during the DT RAGT or not. We measured leg muscle activity with surface electrodes to identify changes in EMG-amplitudes and -patterns.
Twenty-one children participated (7 females, 6.5-17.3 years, Gross Motor Function Classification System (GMFCS) levels I-IV). Most activity measures distinguished significantly between participants performing the DT exergame physiologically or not with moderate to good sensitivity (0.8 ≤ sensitivity≤1.0) and specificity (0.5 ≤ specificity≤0.9). Body function measures differentiated less well. Despite that the EMG-amplitudes of key stance muscles were significantly lower during DT versus no DT exergaming, the mean activation patterns of all muscles correlated high (ρ > 0.75) between the conditions.
This study is the first that investigated effects of a DT exergame during RAGT in children with neurological gait disorders. Several performance measures could differentiate well between patients who walked with physiological versus compensatory movements while performing the DT exergame. While the DT exergame affected the leg muscle activity amplitudes, it did not largely affect the activity patterns of the muscles.
日常生活中的行走是复杂的，需要各种先决条件，如腿部力量、躯干稳定性或认知和运动双重任务（DT）活动。传统的物理疗法可以辅以机器人辅助步态治疗（RAGT）和运动游戏，以增加重复次数、反馈、动机，并在行走之外同时进行其他任务（例如，双重任务（DT）活动）。尽管 DT 步态训练可改善成人患者群体的日常活动能力，但尚无研究评估神经步态障碍儿童的 RAGT 与 DT 运动游戏相结合。因此，我们研究了儿童在 RAGT 中进行 DT 运动游戏时进行生理行走的功能和认知先决条件，并分析了 DT 对腿部肌肉活动的影响。
本准实验研究纳入了患有神经步态障碍的儿童和青少年（6-18 岁），他们在 RAGT 中完成了 DT 运动游戏和非 DT 运动游戏。我们评估了身体功能和活动领域的几个指标（根据国际功能、残疾和健康分类（ICF）），并确定这些指标是否可以很好地区分在 DT RAGT 中生理行走的儿童和不能生理行走的儿童。我们使用表面电极测量腿部肌肉活动，以确定 EMG 幅度和模式的变化。
共有 21 名儿童参与（7 名女性，6.5-17.3 岁，GMFCS 水平 I-IV）。大多数活动指标可以很好地区分生理行走的参与者和非生理行走的参与者，具有中度至高度敏感性（0.8≤敏感性≤1.0）和特异性（0.5≤特异性≤0.9）。身体功能指标的区分效果较差。尽管在进行 DT 运动游戏时关键支撑肌肉的 EMG 幅度明显低于非 DT 运动游戏，但所有肌肉的平均激活模式在两种情况下都高度相关（ρ>0.75）。
本研究首次调查了神经步态障碍儿童在 RAGT 中进行 DT 运动游戏的影响。在进行 DT 运动游戏时，一些运动指标可以很好地区分生理行走的患者和补偿性运动的患者。虽然 DT 运动游戏会影响腿部肌肉活动幅度，但对肌肉的活动模式影响不大。
