Cleland Brice, Madhavan Sangeetha
Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.
Front Neurol. 2021 Apr 1;12:647338. doi: 10.3389/fneur.2021.647338. eCollection 2021.
Decreased walking speeds and spatiotemporal asymmetry both occur after stroke, but it is unclear whether and how they are related. It is also unclear whether rehabilitation-induced improvements in walking speed are associated with improvements in symmetry or greater asymmetry. High-intensity speed-based treadmill training (HISTT) is a recent rehabilitative strategy whose effects on symmetry are unclear. The purpose of this study was to: (1) assess whether walking speed is cross-sectionally associated with spatiotemporal symmetry in chronic stroke, (2) determine whether HISTT leads to changes in the spatiotemporal symmetry of walking, and (3) evaluate whether HISTT-induced changes in walking speed are associated with changes in spatiotemporal symmetry. Eighty-one participants with chronic stroke performed 4 weeks of HISTT. At pre, post, and 3-month follow-up assessments, comfortable and maximal walking speed were measured with the 10-meter walk test, and spatiotemporal characteristics of walking were measured with the GAITRite mat. Step length and swing time were expressed as symmetry ratios (paretic/non-paretic). Changes in walking speed and symmetry were calculated and the association was determined. At pre-assessment, step length and swing time asymmetries were present ( < 0.001). Greater temporal symmetry was associated with faster walking speeds ( ≤ 0.001). After HISTT, walking speeds increased from pre-assessment to post-assessment and follow-up ( ≤ 0.002). There were no changes in spatiotemporal symmetry ( ≥ 0.10). Change in walking speed was not associated with change in spatial or temporal symmetry from pre- to post-assessment or from post-assessment to follow-up (R ≤ 0.01, ≥ 0.37). HISTT improves walking speed but does not systematically improve or worsen spatiotemporal symmetry. Clinicians may need to pair walking interventions like HISTT with another intervention designed to improve walking symmetry simultaneously. The cross-sectional relation between temporal symmetry and walking speed may be mediated by other factors, and not be causative.
中风后步行速度会下降，且会出现时空不对称，但目前尚不清楚它们之间是否存在关联以及如何关联。同样不清楚的是，康复训练所带来的步行速度改善是否与对称性改善或更大程度的不对称性有关。基于速度的高强度跑步机训练（HISTT）是一种新近的康复策略，其对对称性的影响尚不清楚。本研究的目的是：（1）评估慢性中风患者的步行速度与时空对称性之间是否存在横断面关联；（2）确定HISTT是否会导致步行时空对称性的变化；（3）评估HISTT引起的步行速度变化是否与时空对称性变化相关。81名慢性中风患者进行了为期4周的HISTT。在治疗前、治疗后以及3个月随访评估时，采用10米步行测试测量舒适步行速度和最大步行速度，并用GAITRite垫测量步行的时空特征。步长和摆动时间以对称比（患侧/健侧）表示。计算步行速度和对称性的变化并确定其关联性。在治疗前评估时，存在步长和摆动时间不对称（<0.001）。更大的时间对称性与更快的步行速度相关（≤0.001）。经过HISTT后，从治疗前评估到治疗后评估以及随访，步行速度均有所提高（≤0.002）。时空对称性没有变化（≥0.10）。从治疗前评估到治疗后评估以及从治疗后评估到随访，步行速度的变化与空间或时间对称性的变化无关（R≤0.01，≥0.37）。HISTT可提高步行速度，但不会系统性地改善或恶化时空对称性。临床医生可能需要将HISTT这类步行干预措施与另一项旨在同时改善步行对称性的干预措施相结合。时间对称性与步行速度之间的横断面关系可能由其他因素介导，而非因果关系。
