单次特定训练课程可改善中风幸存者在跑步机诱发平衡扰动后的躯干控制能力。
A single session of trip-specific training modifies trunk control following treadmill induced balance perturbations in stroke survivors.
作者信息
Nevisipour Masood, Grabiner Mark D, Honeycutt Claire F
机构信息
School for Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA.
Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
出版信息
Gait Posture. 2019 May;70:222-228. doi: 10.1016/j.gaitpost.2019.03.002. Epub 2019 Mar 5.
BACKGROUND
Individuals with stroke are at significant risk of falling. Trip-specific training is a targeted training approach that has been shown to reduce falls in older adults and amputees by enhancing the compensatory stepping response required to prevent a fall. Still, individuals with stroke have unique deficits (e.g. spasticity) which draws into question if this type of training will be effective for this population.
OBJECTIVE
Evaluate if a single session of trip-specific training can modify the compensatory stepping response (trunk movement, step length/duration, reaction time) of individuals with chronic stroke.
METHODS
Sixteen individuals with unilateral chronic stroke participated in a single session of trip-specific training consisting of 15 treadmill perturbations. A falls assessment consisting of 3 perturbations was completed before and after training. Recovery step kinematics measured during the pre- and post-test were compared using a repeated measures design. Furthermore, Fallers (those who experienced at least one fall during the pre- or post-test) were compared to Non-fallers.
RESULTS
Trip-specific training decreased trunk movement post perturbation. Specifically following training, Trunk flexion was 48 and 19 percent smaller on the small and medium perturbations at the end of the first compensatory step. Fallers (9 out of 16 subjects) post-training resembled Non-Fallers pre-training. Specifically, Trunk flexion at the completion of the first step during small and medium perturbations was not different between Fallers post-training and Non-Fallers pre-training. Still enthusiasm was tempered because Trunk flexion at the largest perturbation (where most falls occurred) was not changed and therefore total falls were not reduced as a result of this training.
SIGNIFICANCE
Our results indicate that trip-specific training modifies the dynamic falls response immediately following trip-like treadmill perturbations. However, the incidence of falls was not reduced with a single training session. Further study of the implications and length of the observed intervention effect are warranted.
背景
中风患者有很高的跌倒风险。特定绊倒训练是一种有针对性的训练方法，已被证明可以通过增强预防跌倒所需的代偿性迈步反应来减少老年人和截肢者的跌倒。然而，中风患者有独特的缺陷（如痉挛），这使得这种类型的训练对该人群是否有效受到质疑。
目的
评估单次特定绊倒训练是否能改变慢性中风患者的代偿性迈步反应（躯干运动、步长/持续时间、反应时间）。
方法
16名单侧慢性中风患者参加了由15次跑步机扰动组成的单次特定绊倒训练。在训练前后完成了由3次扰动组成的跌倒评估。使用重复测量设计比较测试前和测试后测量的恢复步运动学。此外，将跌倒者（在测试前或测试后至少经历一次跌倒的人）与未跌倒者进行比较。
结果
特定绊倒训练减少了扰动后躯干的运动。具体而言，训练后，在第一个代偿性步结束时，小扰动和中扰动时的躯干前屈分别减少了48%和19%。训练后的跌倒者（16名受试者中的9名）类似于训练前的未跌倒者。具体来说，在小扰动和中扰动期间第一步完成时，训练后的跌倒者和训练前的未跌倒者之间的躯干前屈没有差异。然而，由于最大扰动（大多数跌倒发生在此处）时的躯干前屈没有改变，因此跌倒总数并未因该训练而减少，这使得人们的热情有所降温。
意义
我们的结果表明，特定绊倒训练在类似绊倒的跑步机扰动后立即改变了动态跌倒反应。然而，单次训练并没有降低跌倒的发生率。有必要进一步研究观察到的干预效果的影响和持续时间。
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