脊灰幸存者的步行适应能力比健康个体差。

Polio survivors have poorer walking adaptability than healthy individuals.

机构信息

Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.

Department of Human Movement Sciences, Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, Amsterdam, the Netherlands.

出版信息

Gait Posture. 2021 Jun;87:143-148. doi: 10.1016/j.gaitpost.2021.04.031. Epub 2021 Apr 21.

DOI:10.1016/j.gaitpost.2021.04.031

PMID:33915437

Abstract

BACKGROUND

Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.

RESEARCH QUESTION

Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?

METHODS

In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.

RESULTS

46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).

SIGNIFICANCE

Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.

摘要

背景

跌倒在脊灰幸存者中是一个主要的健康问题，常因绊倒、滑倒或踏错脚步而发生。因此，行走适应性降低可能起着重要作用。

研究问题

在交互式跑步机上评估的行走适应性是否在脊灰幸存者和健康个体之间存在差异？

方法

在这项横断面研究中，48 名脊灰幸存者（过去一年至少报告过一次跌倒和/或害怕跌倒）和 25 名年龄相近的健康个体在仪器化跑步机上以自我选择的舒适固定速度行走。行走适应性通过以下三种方式进行测量：i）目标步长准确性（以毫米为单位的变量误差[VE]，与速度无关），在三种条件下：步长和步宽分别变化 0%、20%和 30%；ii）前瞻性和反应性障碍物回避（ObA 和 ObR，以成功回避的百分比表示）。所有试验均检查了有效的步长检测。

结果

46 名脊灰幸存者（平均±标准差年龄：63.2±8.7 岁）和 25 名健康个体（64.3±6.6 岁，p=0.585）显示有效的步长检测。与健康个体（平均±SE VE：30.6±1.2 毫米）相比，脊灰幸存者的目标步长准确性较差（36.4±0.9 毫米，p=0.001），尤其是在他们受影响最小的腿上。脊灰幸存者成功回避的障碍物较少（平均±SE ObA：83±3%，ObR：59±4%），低于健康个体（100±0.3%，p<0.001 和 94±3%，p<0.001），尤其是在从前瞻性障碍物回避到反应性障碍物回避的成功率下降方面，脊灰幸存者更为明显（p<0.001）。