Chayasit Pornprom, Hollands Kristen, Hollands Mark, Boonsinsukh Rumpa
Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok, Thailand.
School of Health Sciences, University of Salford, Salford, UK.
Disabil Rehabil. 2022 Feb;44(3):420-427. doi: 10.1080/09638288.2020.1769205. Epub 2020 Jun 1.
To compare the immediate effects of voluntary-induced stepping response training (VSR) and DynSTABLE perturbation training (DST) on protective stepping in patients with stroke.
A randomized controlled trial (registration number: TCTR20170827001) was conducted in 34 patients with chronic stroke who were randomly allocated to the VSR ( = 17) or DST ( = 17) group. The VSR group was instructed to lean forward to induce protective stepping, while the DST group experienced support surface translation. All participants received one session of training (3 set, 10 min for each set with 10-minute rest in between). Step length, step width, number of steps and center of mass (CoM) position during protective stepping were assessed using a computer-assisted rehabilitation environment (CAREN) system prior to and immediately after training. Two-way ANOVA was used to compare between groups and times.
Both types of training resulted in an increase in step width, but step length increased and there was a more positive COM position exhibited following DST ( < .05) than following VSR. Single-step incidence increased, whereas multiple-step incidence decreased significantly in both groups. Only participants in the VSR group generated protective stepping with the affected leg in a larger percentage of trials (27%) after training than before training.
Both DST and VSR led to changes in protective stepping parameters after a single session of training. VSR may be a feasible alternative to equipment-based training but requires further study.Implication for RehabilitationVSR and DST trainings improved protective stepping in stroke.Step length and CoM control at foot touchdown increased after DST training.VSR training for 50 minutes led to increase affected stepping and reduce grasping.Step width, affected step length, and single step increased after both trainings.Without instrument, VSR increased steps execution and performance similar to DST.
比较自愿诱发踏步反应训练（VSR）和动态稳定扰动训练（DST）对中风患者保护性踏步的即时影响。
对34例慢性中风患者进行了一项随机对照试验（注册号：TCTR20170827001），这些患者被随机分配到VSR组（n = 17）或DST组（n = 17）。VSR组被指导向前倾以诱发保护性踏步，而DST组经历支撑面平移。所有参与者均接受一次训练（3组，每组10分钟，中间休息10分钟）。在训练前和训练后立即使用计算机辅助康复环境（CAREN）系统评估保护性踏步过程中的步长、步宽、步数和重心（CoM）位置。采用双向方差分析比较组间和时间差异。
两种训练方式均导致步宽增加，但步长增加，且DST训练后（P <.05）的重心位置比VSR训练后更积极。两组的单步发生率增加，而多步发生率显著降低。仅VSR组的参与者在训练后比训练前在更大比例的试验（27%）中使用患侧腿产生保护性踏步。
单次训练后，DST和VSR均导致保护性踏步参数发生变化。VSR可能是基于设备训练的一种可行替代方法，但需要进一步研究。
VSR和DST训练改善了中风患者的保护性踏步。DST训练后着地时的步长和CoM控制增加。50分钟的VSR训练导致患侧踏步增加和抓握减少。两种训练后步宽、患侧步长和单步均增加。无需仪器，VSR增加的步执行和表现与DST相似。
