Shin Sung Yul, Lee Robert K, Spicer Patrick, Sulzer James
Department of Mechanical Engineering, University of Texas at Austin, USA.
St. David's Rehabilitation Hospital, St. David's Medical Center, USA.
J Biomech. 2020 May 22;105:109761. doi: 10.1016/j.jbiomech.2020.109761. Epub 2020 Mar 22.
Typical clinical gait outcomes mostly focus on function; only sparse information exists on gait quality, i.e. symmetry or more natural gait patterns. It remains unclear whether functional gait recovery improves with gait quality, or whether these are two independent processes. The objective of this observational pilot study is to examine whether the gait quality improves with gait function (i.e. speed) over the course of early recovery. Full lower body gait kinematics were measured longitudinally in a clinical environment using wearable inertial measurement units. We recorded six individuals with subacute stroke (<1 month) for a total of 56 physical therapy sessions over the initial recovery stage of 12 weeks. We examined relations between gait symmetry in spatiotemporal, limb and joint kinematic parameters compared to gait function. We observed that overall gait symmetry improved with walking speed, but limb and joint kinematic parameters remained asymmetric at the maximum level of recovery (both p < 0.01). We also found that limb kinematic parameters (R = 41.9%) of the impaired side was preferentially associated with functional gait recovery over joint kinematics (R = 33.1%). These data suggest that our pilot cohort did not achieve "true" gait recovery despite achieving typical measures of recovery in gait speed and spatiotemporal symmetry. These initial results illustrate the multifaceted nature of recovery and justify further research on monitoring gait quality with a larger clinical study, providing insight for more effective training regimens.
典型的临床步态结果大多聚焦于功能；关于步态质量（即对称性或更自然的步态模式）的信息却很稀少。目前尚不清楚功能步态恢复是否会随着步态质量的提高而改善，或者这两者是否为两个独立的过程。这项观察性试点研究的目的是检验在早期恢复过程中，步态质量是否会随着步态功能（即速度）的改善而提高。在临床环境中，使用可穿戴惯性测量单元纵向测量整个下肢的步态运动学。我们记录了6名亚急性中风（<1个月）患者在12周的初始恢复阶段总共56次物理治疗课程中的情况。我们研究了时空、肢体和关节运动学参数方面的步态对称性与步态功能之间的关系。我们观察到，总体步态对称性随着步行速度的提高而改善，但在恢复的最大程度时，肢体和关节运动学参数仍不对称（p均<0.01）。我们还发现，与关节运动学（R = 33.1%）相比，患侧的肢体运动学参数（R = 41.9%）与功能性步态恢复的关联更为密切。这些数据表明，尽管我们的试点队列在步态速度和时空对称性方面达到了典型的恢复指标，但并未实现“真正的”步态恢复。这些初步结果说明了恢复的多面性，并证明有必要通过更大规模的临床研究对步态质量监测进行进一步研究，为更有效的训练方案提供见解。
