Osada Yuji, Motojima Naoyuki, Kobayashi Yosuke, Yamamoto Sumiko
Department of Health and Welfare, Tokushima Bunri University, 180 Nishihamahoji, Tokushima 770-8514, Japan.
Showa University, School of Nursing and rehabilitation Science, 1865 Tokaichibacho, Midoriku, Yokohama, Kanagawa 226-8555, Japan.
Clin Biomech (Bristol). 2022 Apr;94:105639. doi: 10.1016/j.clinbiomech.2022.105639. Epub 2022 Apr 1.
Sit-to-walk is an asymmetric task that is challenging for individuals with stroke, and paretic limb loading at seat-off and movement fluidity may change according to whether the non-paretic or paretic leg is used as the leading limb. This study aimed to investigate differences in paretic limb loading and fluidity depending on whether the non-paretic limb or paretic limb was used as the leading limb.
Thirty-eight individuals with stroke performed sit-to-walk with each leg as the leading limb, and their movements were measured using a 3D motion analysis system. The paired t-test or Wilcoxon signed-rank test was used to assess differences according to limb selection in paretic limb loading ratio at seat-off and fluidity (Fluidity Index: ratio of the lowest to peak forward velocity before first initial contact).
Twenty-two of 38 participants preferred to use the paretic limb as the leading limb. When leading with the paretic limb, the paretic limb loading ratio was significantly larger (p = 0.002), and the Fluidity Index was lower (p = 0.007).
Sit-to-walk with the paretic leading limb seems to be an adaptive movement because many participants preferred leading with the paretic limb. However, selection of the leading limb in sit-to-walk involves a biomechanical tradeoff between paretic limb loading at seat-off and movement fluidity in individuals with stroke. Use of the paretic leading limb requires loading capacity of this limb, and the non-paretic leading limb must have high balance ability to merge sit-to-stand and gait initiation.
从坐到走是一项不对称任务，对中风患者具有挑战性，并且在离座时患侧肢体的负重以及动作流畅性可能会因健侧腿还是患侧腿作为主导腿而有所变化。本研究旨在调查根据健侧肢体还是患侧肢体作为主导腿，患侧肢体负重和流畅性的差异。
38名中风患者分别以每条腿作为主导腿进行从坐到走动作，其动作通过三维运动分析系统进行测量。配对t检验或Wilcoxon符号秩检验用于评估根据肢体选择在离座时患侧肢体负重比例和流畅性（流畅性指数：首次初始接触前最低向前速度与峰值向前速度之比）方面的差异。
38名参与者中有22名更倾向于使用患侧肢体作为主导腿。当以患侧肢体作为主导腿时，患侧肢体负重比例显著更大（p = 0.002），且流畅性指数更低（p = 0.007）。
以患侧肢体作为主导腿进行从坐到走似乎是一种适应性动作，因为许多参与者更倾向于以患侧肢体作为主导腿。然而，在从坐到走中选择主导腿涉及中风患者在离座时患侧肢体负重与动作流畅性之间的生物力学权衡。使用患侧肢体作为主导腿需要该肢体具备负重能力，而健侧肢体作为主导腿则必须具备较高的平衡能力以衔接坐立和步态起始动作。
