Echigoya Kazutaka, Okada Kyoji, Wakasa Masahiko, Saito Akira, Kimoto Minoru, Suto Akiyoshi
Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, 352 Gohyakukarita, Kamiyodokawa, Kyouwa, Daisen City, Akita, 019-2492, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1 Hondo 1-chome, Akita City, Akita, 010-8543, Japan.
Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1 Hondo 1-chome, Akita City, Akita, 010-8543, Japan.
Gait Posture. 2021 Oct;90:307-312. doi: 10.1016/j.gaitpost.2021.09.181. Epub 2021 Sep 23.
Abnormal foot contact patterns following stroke affect functional gait; however, objective analysis targeting independent walking is lacking.
How do walking abilities and foot pressure patterns differ between post-stroke individuals who achieved independent walking and healthy controls? Secondarily, how do the abilities and patterns in post-stroke individuals change before and after achieving independent walking? Can these changes become criteria for permitting independent walking?
Twenty-eight individuals with hemiplegia and 32 controls were enrolled. Motor dysfunction score (MDScore), walking speed (WSpeed), and foot pressure patterns were measured when they were first able to walk without orthosis or physical assistance (1st assessment) and when they achieved independent walking around discharge (2nd assessment). Foot pressure patterns were measured using insole-type foot pressure-measuring system. Ratios of partial foot pressure to body weight (%PFP), ratios of anteroposterior length of center of pressure (COP; %Long), and backward moving distance of COP to the foot length (%Backward) were calculated. Parameters during the 2nd assessment were compared with those of controls and those during the 1st assessment. During the 2nd assessment, relationships among the parameters, MDScore, and WSpeed were analyzed.
During the 2nd assessment, no difference was observed in both %Long and %Backward between the non-paretic limbs and the controls. While the %Backward was higher, the %PFP of toes and %Long were lower in the paretic limb than in the controls. Although the %Backward was lower, both %PFP of toes and %Long of the paretic limb were higher in the 2nd assessment than in the 1st assessment. During the 2nd assessment, both %Long and % Backward values of the paretic limb moderately correlated with MDScore and WSpeed.
After improvement of foot pressure in toes, both an increase in anteroposterior length and a decrease in backward moving of COP path were objective signs permitting independent walking.
中风后异常的足部接触模式会影响功能性步态；然而，针对独立行走的客观分析尚缺乏。
在实现独立行走的中风后个体与健康对照者之间，行走能力和足部压力模式有何不同？其次，中风后个体在实现独立行走前后，其能力和模式如何变化？这些变化能否成为允许独立行走的标准？
招募了28名偏瘫个体和32名对照者。在他们首次能够在无矫形器或物理辅助的情况下行走时（第一次评估）以及在出院前后实现独立行走时（第二次评估），测量运动功能障碍评分（MDScore）、步行速度（WSpeed）和足部压力模式。使用鞋垫式足部压力测量系统测量足部压力模式。计算部分足部压力与体重的比值（%PFP）、压力中心前后长度的比值（COP；%Long）以及COP相对于足长的向后移动距离（%Backward）。将第二次评估期间的参数与对照者的参数以及第一次评估期间的参数进行比较。在第二次评估期间，分析参数、MDScore和WSpeed之间的关系。
在第二次评估期间，非患侧肢体与对照者之间在%Long和%Backward方面均未观察到差异。虽然%Backward较高，但患侧肢体的脚趾%PFP和%Long低于对照者。尽管%Backward较低，但患侧肢体的脚趾%PFP和%Long在第二次评估中均高于第一次评估。在第二次评估期间，患侧肢体的%Long和%Backward值均与MDScore和WSpeed呈中度相关。
在脚趾部足部压力改善后，压力中心路径前后长度的增加和向后移动的减少均是允许独立行走的客观标志。
