Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok, 26120, Thailand.
School of Health Sciences, University of Salford, Salford, M6 6PU, United Kingdom.
Gait Posture. 2020 Oct;82:75-82. doi: 10.1016/j.gaitpost.2020.08.125. Epub 2020 Aug 29.
Impairment of protective steps to recover balance from external perturbation is evident after stroke. Voluntary-induced stepping response (VSR) can be used to practice protective steps by instructing an individual to voluntarily lean their whole body forward until they perceive a loss of balance and automatically induce a step. However, to improve protective stepping performance, detailed characteristics of VSR in healthy persons are required.
What is the difference in VSR between healthy and persons with stroke?
An observational study was conducted in 30 participants, (10 young, 10 older, and 10 persons with stroke). All participants performed VSR for 10 trials. Step length, step width, step duration, CoM position, CoM velocity, trunk-hip displacement, and strategies of response were recorded using a motion capture system and analysed using Matlab software. Statistical analysis was performed using One-way ANOVA and Chi-square.
On average, participants with stroke had shorter step lengths and step durations than young and older adults. Step width of older adults and participants with stroke was wider than that of young adults (p < 0.05). While multiple steps and losing balance were reported more frequently in participants with stroke than the others, the percentage of trials in which participants grasped the handrails was not significantly different between older adults and participants with stroke. CoM position, CoM velocity, and trunk-hip displacement at foot liftoff were significantly smaller in older adults and participants with stroke than young adults (p < 0.05). Participants with stroke tended to use trunk bending rather than trunk leaning strategies to generate VSR in contrast to healthy participant. The prevalence of the trunk bending strategy was also greater in older adults than young adults.
Values obtained from healthy groups can be used as guidelines to set realistic goals during VSR training to improve protective steps in patients with stroke.
脑卒中后，从外部干扰中恢复平衡的保护措施受损。自愿诱导的迈步反应（VSR）可以通过指导个体自愿向前倾斜整个身体，直到他们感觉到失去平衡并自动诱导迈步，从而用于练习保护措施。然而，为了提高保护跨步的性能，需要了解健康人 VSR 的详细特征。
健康人与脑卒中患者的 VSR 有何不同？
本研究进行了一项观察性研究，共有 30 名参与者参与，（10 名年轻人、10 名老年人和 10 名脑卒中患者）。所有参与者进行了 10 次 VSR 试验。使用运动捕捉系统记录步长、步宽、步幅持续时间、质心位置、质心速度、躯干-臀部位移，并使用 Matlab 软件进行分析。使用 One-way ANOVA 和卡方检验进行统计学分析。
平均而言，脑卒中患者的步长和步幅持续时间短于年轻人和老年人。老年人和脑卒中患者的步宽大于年轻人（p<0.05）。虽然脑卒中患者比其他参与者更频繁地报告多次迈步和失去平衡，但老年人和脑卒中患者抓扶手的试验百分比与年轻人无显著差异。老年人和脑卒中患者的质心位置、质心速度和脚离地时的躯干-臀部位移明显小于年轻人（p<0.05）。与健康参与者相比，脑卒中患者倾向于使用躯干弯曲策略而不是躯干倾斜策略来产生 VSR。老年人的躯干弯曲策略的发生率也高于年轻人。
可以将从健康组获得的值用作在 VSR 训练中设定现实目标的指南，以改善脑卒中患者的保护措施。
