AlHakeem Nojoud, Ouellette Elizabeth Anne, Travascio Francesco, Asfour Shihab
Biomechanics Research Laboratory, Department of Industrial Engineering, University of Miami, Coral Gables, FL, United States.
Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, United States.
Front Bioeng Biotechnol. 2020 Feb 21;8:116. doi: 10.3389/fbioe.2020.00116. eCollection 2020.
Spasticity of the upper extremity often occurs after injury to the upper motor neurons (UMN). This condition can greatly interfere with the hand positioning in space and the functional use of the arm, affecting many daily living activities including walking. As gait and balance involve the coordination of all segments of the body, the control of upper limbs movement is necessary for smooth motion and stability. The purpose of this study was to assess the effects of surgical interventions on upper extremity spasticity to gait patterns in three spastic patients, as a way to assess the effect on patient's mobility.
Three patients with an anoxic brain injury, upper extremity spasticity, and an altered gait participated in this study. A specific treatment plan based on the patient was tailored by the orthopedic hand surgeon to help release the contractures and spastic muscles. Three-dimensional gait analysis was performed before surgery, 3, 6, and 12 months postoperatively. During each experimental session, the patient walked at a self-selected pace in a straight line across four force plates embedded into the floor (Kistler). Motion data were acquired using Vicon Motion Capturing System. Spatiotemporal measurements as well as bilateral kinematics of the hip, knee and ankle were studied. The results from matched non-disabled controls were included as reference.
Overtime, clinical assessment displayed recovery in hand functions and restored sensation in the fingers. Gait analysis results demonstrated overall improvements in spatiotemporal parameters, specifically in cadence and walking speed. Improvements in kinematics of the lower limbs were also evident.
The results of this study indicated that, within a timeframe of one year, gait patterns improved in all patients. These observations suggest that, over time, upper limb surgery has the potential to improve the biomechanics of gait in spastic patients.
上肢痉挛常发生在上运动神经元（UMN）损伤后。这种情况会极大地干扰手部在空间中的定位以及手臂的功能使用，影响包括行走在内的许多日常生活活动。由于步态和平衡涉及身体所有部位的协调，上肢运动的控制对于平稳运动和稳定性是必要的。本研究的目的是评估手术干预对三名痉挛患者上肢痉挛及步态模式的影响，以此评估对患者活动能力的影响。
三名患有缺氧性脑损伤、上肢痉挛且步态改变的患者参与了本研究。骨科手外科医生根据患者情况制定了特定的治疗方案，以帮助松解挛缩和痉挛的肌肉。在手术前、术后3个月、6个月和12个月进行三维步态分析。在每个实验环节中，患者以自己选择的速度在一条直线上行走，穿过嵌入地面的四个测力板（奇石乐公司）。使用Vicon运动捕捉系统采集运动数据。研究了时空测量以及髋、膝和踝关节的双侧运动学。将匹配的非残疾对照的结果作为参考纳入。
随着时间的推移，临床评估显示手部功能恢复，手指感觉恢复。步态分析结果表明时空参数总体有所改善，特别是步频和步行速度。下肢运动学也有明显改善。
本研究结果表明，在一年的时间范围内，所有患者的步态模式均有改善。这些观察结果表明，随着时间的推移，上肢手术有可能改善痉挛患者的步态生物力学。
