一种针对帕金森病患者的新步态训练方法。

A new approach toward gait training in patients with Parkinson's Disease.

机构信息

Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.

McGill Movement Disorder Clinic, McGill University, Montreal, H3A 2B4, Canada.

出版信息

Gait Posture. 2020 Sep;81:14-20. doi: 10.1016/j.gaitpost.2020.06.031. Epub 2020 Jun 29.

DOI:10.1016/j.gaitpost.2020.06.031

PMID:32650238

Abstract

BACKGROUND

Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training.

RESEARCH QUESTION

Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe.

METHODS

Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV).

RESULTS

An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking.

SIGNIFICANCE

Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.

摘要

背景

通常，帕金森病（PD）患者会逐渐形成一种步态模式，其特点是步伐急促、短促且拖曳。步态周期发生改变，缺乏清晰度和流畅性。PD 的步态训练通常结合多种反馈模式，这些模式基于非即时和外部线索，但没有一种模式可以提供关于步态质量的实时反馈，而且获得的收益在康复后不久往往会减弱。基于运动学习原理，我们的团队开发了 Heel2Toe 传感器，在步态训练过程中提供实时听觉反馈。

研究问题

短期使用 Heel2Toe 传感器进行训练是否可行且高效，能否改善 PD 患者的步态？我们的目标是确定在同一治疗过程中，反馈的即时反应程度和训练的延续反应程度；2）确定患者使用 Heel2Toe 的感觉、乐趣和挑战。

方法

单臂、概念验证研究。六名患者在 2-3 周的时间内，使用 Heel2Toe 传感器进行了五次步态训练，同时还进行了移动性练习作为步态训练的辅助。主要结果是在 2 分钟步行测试中收集的技术评估步态参数，包括有无反馈。分析 Heel2Toe 信号以提取角速度（AV）、良好步幅百分比、平均步频和 AV 变异系数（CV）。