Bourbonnais Daniel, Pelletier René, Azar Joëlle, Sille Camille, Goyette Michel
School of Rehabilitation, Université de Montréal, P.O. Box 6128, Pavillon du Parc, Bureau 403-8, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada.
BMC Biomed Eng. 2021 Oct 29;3(1):12. doi: 10.1186/s42490-021-00057-5.
Controlled static exertion performed in the sagittal plane on a transducer attached to the foot requires coordinated moments of force of the lower extremity. Some exertions and plantarflexion recruit muscular activation patterns similar to synergies previously identified during gait. It is currently unknown if persons with hemiparesis following stroke demonstrate similar muscular patterns, and if force feedback training utilizing static exertion results in improved mobility in this population.
Electromyographic (EMG) activity of eight muscles of the lower limb were recorded using surface electrodes in healthy participants (n = 10) and in persons with hemiparesis (n = 8) during an exertion exercise (task) performed in eight directions in the sagittal plane of the foot and a plantarflexion exercise performed at 20 and 40% maximum voluntary effort (MVE). Muscle activation patterns identified during these exertion exercises were compared between groups and to synergies reported in the literature during healthy gait using cosine similarities (CS). Functional mobility was assessed in four participants with hemiparesis using GAITRite® and the Timed Up and Go (TUG) test at each session before, during and after static force feedback training. Tau statistics were used to evaluate the effect on mobility before and after training. Measures of MVE and the accuracy of directional exertion were compared before and after training using ANOVAs. Spearman Rho correlations were also calculated between changes in these parameters and changes in mobility before and after the training.
Muscle activation patterns during directional exertion and plantarflexion were similar for both groups of participants (CS varying from 0.845 to 0.977). Muscular patterns for some of the directional and plantarflexion were also similar to synergies recruited during gait (CS varying from 0.847 to 0.951). Directional exertion training in hemiparetic subjects resulted in improvement in MVE (p < 0.040) and task performance accuracy (p < 0.001). Hemiparetic subjects also demonstrated significant improvements in gait velocity (p < 0.032) and in the TUG test (p < 0.022) following training. Improvements in certain directional efforts were correlated with changes in gait velocity (p = 0.001).
Static force feedback training following stroke improves strength and coordination of the lower extremity while recruiting synergies reported during gait and is associated with improved mobility.
在附着于足部的传感器上在矢状面进行的受控静态用力需要下肢的协调力矩。一些用力和跖屈会募集与先前在步态中确定的协同作用相似的肌肉激活模式。目前尚不清楚中风后偏瘫患者是否表现出类似的肌肉模式，以及利用静态用力的力反馈训练是否会改善该人群的活动能力。
在健康参与者（n = 10）和偏瘫患者（n = 8）中，使用表面电极记录下肢八块肌肉在足部矢状面八个方向进行的用力运动（任务）以及在最大自主用力（MVE）的20%和40%进行的跖屈运动过程中的肌电图（EMG）活动。使用余弦相似度（CS）比较两组在这些用力运动中识别出的肌肉激活模式，并与文献中报道的健康步态中的协同作用进行比较。在静态力反馈训练前、训练期间和训练后，使用GAITRite®和定时起立行走（TUG）测试对四名偏瘫参与者的功能活动能力进行评估。使用Tau统计量评估训练前后对活动能力的影响。使用方差分析比较训练前后的MVE测量值和定向用力的准确性。还计算了这些参数的变化与训练前后活动能力变化之间的Spearman Rho相关性。
两组参与者在定向用力和跖屈过程中的肌肉激活模式相似（CS在0.845至0.977之间）。一些定向和跖屈的肌肉模式也与步态中募集的协同作用相似（CS在0.847至0.951之间）。偏瘫受试者的定向用力训练导致MVE改善（p < 0.040）和任务表现准确性提高（p < 0.001）。偏瘫受试者在训练后的步态速度（p < 0.032）和TUG测试（p < 0.022）中也表现出显著改善。某些定向用力的改善与步态速度的变化相关（p = 0.001）。
中风后的静态力反馈训练可提高下肢的力量和协调性，同时募集步态中报道的协同作用，并与活动能力的改善相关。
