Wakida Masanori, Ohata Koji, Hashiguchi Yu, Mori Kimihiko, Hase Kimitaka, Yamada Shigehito
Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Rehabilitation, Kansai Medical University Kori Hospital, Osaka, Japan.
Rehabil Res Pract. 2020 May 19;2020:2397374. doi: 10.1155/2020/2397374. eCollection 2020.
Twenty-two community-dwelling patients with chronic hemiplegia participated in this study. Eight participants performed only discrete-skill step training during the loading response phase, focusing on paretic hip extension movement (LR group). Another eight performed only discrete-skill step training during the preswing phase, focusing on paretic swing movement (PSw group). The remaining six were trained using both training methods, with at least 6 months in each group to washout the influence of previous training. Therefore, the final number of participants in each group was 14. The braking and propulsive forces of GRFs were measured during gait before and after 30 repetitions of the discrete-skill step training.
Although both groups showed a significant increase in stride length, walking speed was increased only in the LR group. The PSw group showed an increase in braking forces of both sides without any change in propulsion. In the LR group, paretic braking impulse did not change, while nonparetic propulsion increased.
The discrete-skill step training during loading response phase induced an increase in nonparetic propulsion, resulting in increased walking speed. This study provides a clear understanding of immediate effects of the discrete-skill step training in patients with chronic stroke and helps improve interventions in long-term rehabilitation.
22名社区居住的慢性偏瘫患者参与了本研究。8名参与者仅在负重反应阶段进行离散技能步训练，重点是患侧髋关节伸展运动（LR组）。另外8名参与者仅在摆动前期进行离散技能步训练，重点是患侧摆动运动（PSw组）。其余6名患者使用两种训练方法进行训练，每组至少训练6个月以消除先前训练的影响。因此，每组最终参与者人数为14名。在进行30次离散技能步训练前后的步态过程中测量地面反作用力的制动力和推进力。
尽管两组的步幅均显著增加，但仅LR组的步行速度增加。PSw组两侧的制动力增加，推进力无变化。在LR组中，患侧制动冲量未改变，而非患侧推进力增加。
负重反应阶段的离散技能步训练可导致非患侧推进力增加，从而提高步行速度。本研究明确了离散技能步训练对慢性卒中患者的即时效果，有助于改善长期康复干预。
