Department of Medicine, University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand; Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.
Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.
Gait Posture. 2021 Jun;87:156-162. doi: 10.1016/j.gaitpost.2021.04.035. Epub 2021 Apr 25.
Step length asymmetry is common after stroke. Unilateral step training (UST) can improve step length asymmetry for patients who take a longer step with their paretic leg (P-long). UST has not been tested with patients who take a shorter step with their paretic leg (P-short).
Does training patients according to the direction of their asymmetry improve step length asymmetry?
Adults 18 years and older with asymmetrical gait at least 6 months post-stroke completed three 20 min treadmill training sessions at least 48 h apart: Conventional treadmill; UST with the non-paretic leg stationary on the side of the treadmill and the paretic leg stepping on the moving treadmill belt (P-stepping); and UST with the paretic leg stationary on the side of the treadmill and the non-paretic leg stepping on the moving belt (NP-stepping). Spatiotemporal gait parameters before, immediately, 10 min and 30 min after training were recorded at self-selected and fastest walking pace. Asymmetry values for each parameter were calculated. RmANOVAs were used to investigate the effects of training type on spatiotemporal parameters and paired-samples t-tests used to investigate potential contributors to training effects on asymmetry.
Twenty participants (16 male, median age 65 (43-80) years; 11 P-long, 9 P-short) were included. Improvements in step length asymmetry were observed immediately after both Conventional (9.1 %; 95 % CI 2.7-15.4%) and P-stepping (11.6 %; 95 % CI 5.3-17.8 %) treadmill training in participants who take a shorter step with their paretic leg, however effects were only sustained after Conventional training. Step length asymmetry did not improve for P-long participants with any training type.
The effectiveness of unilateral step training may be related to the direction of step length asymmetry. Further investigation is required before considering using unilateral step training as a rehabilitation tool for gait asymmetry after stroke.
脑卒中后步长不对称很常见。单侧步训练（UST）可以改善患侧步长较长的患者（P-长）的步长不对称。尚未对患侧步长较短的患者（P-短）进行 UST 测试。
根据不对称的方向训练患者是否可以改善步长不对称？
至少 6 个月有步态不对称的成年人完成了三次至少相隔 48 小时的 20 分钟跑步机训练：常规跑步机训练、非患侧腿固定在跑步机侧、患侧腿踏在移动的跑步机带上（P-踏）的 UST（P-踏）和患侧腿固定在跑步机侧、非患侧腿踏在移动带上的 UST（NP-踏）。在自我选择和最快步行速度下，在训练前、立即、10 分钟和 30 分钟记录时空步态参数。为每个参数计算不对称值。使用重复测量方差分析研究训练类型对时空参数的影响，使用配对样本 t 检验研究训练对不对称影响的潜在贡献。
共有 20 名参与者（16 名男性，中位数年龄 65（43-80）岁；11 名 P-长，9 名 P-短）被纳入。在 P-短患者中，立即观察到常规（9.1%；95%CI 2.7-15.4%）和 P-踏（11.6%；95%CI 5.3-17.8%）跑步机训练后，步长不对称得到改善，但只有常规训练后才持续改善。对于任何训练类型的 P-长患者，步长不对称都没有改善。
单侧步训练的有效性可能与步长不对称的方向有关。在考虑将单侧步训练作为脑卒中后步态不对称的康复工具之前，还需要进一步研究。
