National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, South Korea.
Department of Physical Therapy, Sahmyook University College of Health Science, Seoul, South Korea.
Gait Posture. 2021 Jun;87:177-183. doi: 10.1016/j.gaitpost.2021.04.011. Epub 2021 Apr 15.
Ankle dysfunction in patients with stroke is a common but serious cause of balance and gait impairments. However, comprehensive paretic ankle training seldom exists. Thus, we investigated the effects of a bi-axial ankle muscle training program using visual feedback as a means to improve ankle strength and performance of functional activities in patients with stroke.
This study was a randomized controlled pilot trial with concealed allocation and assessor blinding and intention-to-treat analysis. Twenty-five patients with stroke and difficulty in walking (e.g., foot drop) or ankle muscle weakness receiving inpatient rehabilitation were included. The experimental group underwent ankle muscle training consisting of passive stretching, control of ankle muscles, and active-resistive strengthening using visual feedback for 40 min per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy, including ankle range-of-motion exercises. The amount of time for training was equal between the two groups. The outcome measurements were isometric ankle contraction force to assess the strength of ankle muscles, ankle proprioception, Fugl-Meyer lower extremity score, Berg balance scale score, walking speed, and ankle co-contraction index to assess muscle efficiency during gait.
The analysis revealed significant between-group differences in the ankle muscle strength in each direction (P < 0.05), Fugl-Meyer score (P < 0.01), and stance-phase co-contraction index (P < 0.05). After training, the experimental group displayed significant within-group differences in the strength of the ankle muscles in each direction (P < 0.01), ankle proprioception (P < 0.05), and walking speed (P < 0.05).
Our findings demonstrate the significant short-term effects of ankle muscle training on strength, walking speed, and muscle efficiency in patients with chronic stroke.
脑卒中患者的踝关节功能障碍是导致平衡和步态受损的常见但严重的原因。然而，全面的瘫痪踝关节训练却很少见。因此，我们研究了使用视觉反馈的双轴踝关节肌肉训练计划对改善脑卒中患者踝关节力量和功能活动表现的影响。
这是一项随机对照的初步试验，采用隐藏分组、评估者盲法和意向治疗分析。纳入了 25 名患有脑卒中且行走困难（如足下垂）或踝关节肌肉无力的住院康复患者。实验组接受了包括被动拉伸、踝关节肌肉控制和使用视觉反馈进行主动抗阻强化的踝关节肌肉训练，每天 40 分钟，每周 5 次，持续 4 周。对照组接受了包括踝关节活动范围练习在内的踝关节相关物理治疗。两组的训练时间相等。疗效评估指标包括等长踝关节收缩力（评估踝关节肌肉力量）、踝关节本体感觉、Fugl-Meyer 下肢评分、Berg 平衡量表评分、步行速度和踝关节协同收缩指数（评估步态时的肌肉效率）。
分析显示，在各个方向的踝关节肌肉力量（P < 0.05）、Fugl-Meyer 评分（P < 0.01）和站立相协同收缩指数（P < 0.05）方面，两组间存在显著差异。训练后，实验组在各个方向的踝关节肌肉力量（P < 0.01）、踝关节本体感觉（P < 0.05）和步行速度（P < 0.05）方面均表现出显著的组内差异。
我们的研究结果表明，踝关节肌肉训练对慢性脑卒中患者的力量、步行速度和肌肉效率具有显著的短期影响。
