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步态起始和越过障碍物过程中的姿势调整与生物力学:运动不能-强直型和运动增多型帕金森病的比较

Postural Adjustments and Biomechanics During Gait Initiation and Obstacle Negotiation: A Comparison Between Akinetic-Rigid and Hyperkinetic Parkinson's Disease.

作者信息

Casal Marcela Zimmermann, Peyré-Tartaruga Leonardo Alexandre, Zanardi Ana Paula Janner, Ivaniski-Mello André, Alves Lucas de Liz, Haas Aline Nogueira, Martinez Flávia Gomes

机构信息

Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.

Physical Therapy College, Centro Universitário de Cascavel (UNIVEL), Cascavel, Brazil.

出版信息

Front Physiol. 2021 Nov 4;12:723628. doi: 10.3389/fphys.2021.723628. eCollection 2021.

Abstract

Individuals with Parkinson's disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence. To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls. Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R ( = 16) and HYP ( = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent -tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05). In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support ( = 0.01), longer time for double support ( = 0.01) accompanied by a smaller first step (size, = 0.05; height, = 0.04), and reduced muscle activation of obliquus internus ( = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height ( = 0.01) and hip excursion ( = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure ( = 0.02) during APA, and activation of the gluteus medius ( = 0.02) and the anterior tibialis ( = 0.04) during CPA in comparison with HYP group. The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation.

摘要

帕金森病(PD)患者表现出不同的运动症状组合。最常见的亚型是运动不能-强直型(AK-R)和多动型(HYP)。运动症状,如强直和运动迟缓,可直接影响姿势调整和日常任务表现,如步态起始和越过障碍物,增加跌倒风险和功能依赖。比较AK-R型和HYP型PD患者在步态起始和越过障碍物过程中的姿势调整和生物力学参数,并将其与功能活动能力和跌倒风险相关联。横断面研究。33名PD志愿者根据临床运动表现分为两组:AK-R组(n = 16)和HYP组(n = 17)。我们在步态起始和越过障碍物测试期间,通过分析运动学、动力学和肌电图参数,评估预期(APA)、代偿(CPA)姿势调整。我们分别应用独立样本t检验和Pearson相关检验进行比较和相关性分析(α = 0.05)。在步态起始测试的APA阶段,与功能正常的HYP组相比,AK-R组单支撑时间更短(P = 0.01),双支撑时间更长(P = 0.01),同时第一步更小(步幅,P = 0.05;步高,P = 0.04),腹内斜肌肌肉激活减少(P = 0.02)。同样,在越过障碍物测试的第一步期间,与HYP组相比,AK-R组步高更小(P = 0.01),髋部偏移更小(P = 0.02),在APA期间压力中心的内外侧位移减少(P = 0.02),在CPA期间臀中肌(P = 0.02)和胫前肌(P = 0.04)激活减少。研究结果表明,与多动型PD相比。AK-R型患者在步态起始和越过障碍物过程中姿势调整受损。基于确定的运动症状,本文提出的观点揭示了复杂任务期间一致的姿势调整,因此可能为PD运动评估和神经康复提供新的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/29cd/8600270/c563419ad343/fphys-12-723628-g001.jpg

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