Hösl Matthias, Böhm Harald, Eck Justine, Döderlein Leonhard, Arampatzis Adamantios
Schön Klinik Bad Aibling, Hospital for Neurology and Neurological Rehabilitation, Kolbermoorerstr. 72, 83043 Bad Aibling, Germany.
Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229 Aschau im Chiemgau, Germany.
Gait Posture. 2018 Sep;65:121-128. doi: 10.1016/j.gaitpost.2018.07.171. Epub 2018 Jul 22.
Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function.
What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy?
10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study. One group started with manual static stretching, the other one with backward-downhill treadmill training. Each treatment period lasted 9 weeks (3 sessions per week). Pre and post treatments, 3D gait was assessed during comfortable and during fastest possible walking. Ultrasonography and dynamometry were used to test plantarflexor strength, passive joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level.
When comparing both treatments, backward-downhill treadmill training lead to larger single stance dorsiflexion at comfortable walking speed (+2.9°, P = 0.041) and faster maximally achievable walking velocities ( + 0.10 m/s, P = 0.017). Stretching reduced knee flexion in swing, particularly at faster walking velocities (-5.4°, P = 0.003). Strength, ankle joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered, despite similar increases in passive muscle and fascicle strain with both treatments (P ≤ 0.023).
Backward-downhill treadmill training can be an effective gait treatment, probably improving coordination or reducing dynamic stretch sensitivity. More intense BDTT might be necessary to further alter muscle-tendon properties. Manual static plantarflexor stretching may not be optimal in Cerebral Palsy patients with high ambulatory status.
痉挛型脑瘫患者容易出现马蹄内翻畸形，可能受到足底屈肌短缩和不可伸展的影响。手法拉伸是一种常用的治疗方法，但其在关节活动度、肌腱形态学和步行功能方面的有效性存在争议。通过下坡倒走跑步机训练进行的离心运动可能是改善步态和肌肉功能的门诊患者的一种治疗选择。
下坡倒走跑步机训练和足底屈肌拉伸进行的离心训练对痉挛型脑瘫患者的步态和肌肉功能有何影响？
10名独立行走的痉挛型脑瘫患者（年龄12 [标准差4]岁，2名单侧受累，8名双侧受累）参与了一项随机交叉研究。一组从手法静态拉伸开始，另一组从下坡倒走跑步机训练开始。每个治疗期持续9周（每周3次）。治疗前后，在舒适步行和尽可能快的步行过程中评估三维步态。使用超声和测力法测试足底屈肌力量、被动关节灵活性，以及腓肠肌形态学、肌腱和关节水平的刚度和应变。
比较两种治疗方法时，下坡倒走跑步机训练在舒适步行速度下导致更大的单支撑背屈（增加2.9°，P = 0.041）和更快的最大可行走速度（增加0.10 m/s，P = 0.017）。拉伸减少了摆动期的膝关节屈曲，尤其是在更快的步行速度下（减少5.4°，P = 0.003）。尽管两种治疗方法在被动肌肉和肌束应变方面有相似的增加（P≤0.023），但力量、踝关节灵活性以及肌腱和关节水平的刚度没有改变。
下坡倒走跑步机训练可能是一种有效的步态治疗方法，可能改善协调性或降低动态拉伸敏感性。可能需要更强烈的BDTT来进一步改变肌腱特性。对于高步行能力的脑瘫患者，手法静态足底屈肌拉伸可能不是最佳选择。
Zotero 插件