School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.
International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
J Neuroeng Rehabil. 2019 Aug 28;16(1):107. doi: 10.1186/s12984-019-0575-z.
Individuals with motor-incomplete SCI (m-iSCI) remain limited community ambulators, partly because they have difficulty with the skilled walking requirements of everyday life that require adaptations in inter-joint coordination and range of motion of the lower limbs. Following locomotor training, individuals with SCI show improvements in skilled walking and walking speed, however there is limited understanding of how adaptations in lower limb kinematics following training contribute to improvements in walking.
To determine the relationship between changes in lower limb kinematics (range of motion and inter-joint coordination) and improvements in walking function (walking speed and skilled walking) following locomotor training.
Lower limb kinematics were recorded from 8 individuals with chronic m-iSCI during treadmill walking before and after a 3-month locomotor training program. Data were also collected from 5 able-bodied individuals to provide normative values. In individuals with SCI, muscle strength was used to define the stronger and weaker limb. Motion analysis was used to determine, hip, knee and ankle angles. Joint angle-angle plots (cyclograms) were used to quantify inter-joint coordination. Shape differences between pre-and post-training cyclograms were used to assess the changes in coordination and their relation to improvements in walking function. Walking function was assessed using the 10MWT for walking speed and the SCI-FAP for skilled walking. Comparing pre- and post-training cyclograms to the able-bodied pattern was used to understand the extent to which changes in coordination involved the recovery of normative motor patterns.
Following training, improvements in skilled walking were significantly related to changes in hip-ankle coordination (ρ = - .833, p = 0.010) and knee range of motion (ρ = .833, p = 0.010) of the weaker limb. Inter-joint coordination tended to revert towards normative patterns, but not completely. No relationships were observed with walking speed.
Larger changes in hip-ankle coordination and a decrease in knee range of motion in the weaker limb during treadmill walking were related to improvements in skilled walking following locomotor training in individuals with SCI. The changes in coordination seem to reflect some restoration of normative patterns and the adoption of compensatory strategies, depending on the participant.
运动不完全性脊髓损伤（m-iSCI）患者仍然是有限的社区步行者，部分原因是他们难以适应日常生活中需要下肢关节协调和运动范围适应的熟练步行要求。在进行运动训练后，SCI 患者的熟练步行和步行速度都有所提高，但对于训练后下肢运动学的适应性如何有助于提高步行能力的理解有限。
确定运动训练后下肢运动学（运动范围和关节间协调）的变化与步行功能（步行速度和熟练步行）改善之间的关系。
在进行为期 3 个月的运动训练计划前后，从 8 名慢性 m-iSCI 患者在跑步机上行走时记录下肢运动学。还从 5 名健全人收集数据以提供正常值。在 SCI 患者中，肌肉力量用于定义较强和较弱的肢体。运动分析用于确定髋关节、膝关节和踝关节角度。关节角度-角度图（循环图）用于量化关节间协调。使用预训练和训练后循环图之间的形状差异来评估协调的变化及其与步行功能改善的关系。使用 10MWT 评估步行速度，使用 SCI-FAP 评估熟练步行。将预训练和训练后循环图与健全人的模式进行比较，以了解协调变化在多大程度上涉及恢复正常运动模式。
训练后，熟练步行的改善与较弱侧髋关节-踝关节协调（ρ= -.833，p= 0.010）和膝关节运动范围（ρ= -.833，p= 0.010）的变化显著相关。关节间协调趋于恢复到正常模式，但不完全。与步行速度无关系。
在 SCI 患者进行跑步机行走时，较弱侧髋关节-踝关节协调的变化较大，膝关节运动范围减小与运动训练后熟练步行的改善有关。协调的变化似乎反映了正常模式的一些恢复，以及根据参与者的不同而采用补偿策略。
