Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA, 90033, USA.
Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.
J Neuroeng Rehabil. 2023 Jan 27;20(1):14. doi: 10.1186/s12984-023-01139-2.
Gait training at fast speeds is recommended to reduce walking activity limitations post-stroke. Fast walking may also reduce gait kinematic impairments post-stroke. However, it is unknown if differences in gait kinematics between people post-stroke and neurotypical adults decrease when walking at faster speeds.
To determine the effect of faster walking speeds on gait kinematics post-stroke relative to neurotypical adults walking at similar speeds.
We performed a secondary analysis with data from 28 people post-stroke and 50 neurotypical adults treadmill walking at multiple speeds. We evaluated the effects of speed and group on individual spatiotemporal and kinematic metrics and performed k-means clustering with all metrics at self-selected and fast speeds.
People post-stroke decreased step length asymmetry and trailing limb angle impairment, reducing between-group differences at fast speeds. Speed-dependent changes in peak swing knee flexion, hip hiking, and temporal asymmetries exaggerated between-group differences. Our clustering analyses revealed two clusters. One represented neurotypical gait behavior, composed of neurotypical and post-stroke participants. The other characterized stroke gait behavior-comprised entirely of participants post-stroke with smaller lower extremity Fugl-Meyer scores than the post-stroke participants in the neurotypical gait behavior cluster. Cluster composition was largely consistent at both speeds, and the distance between clusters increased at fast speeds.
The biomechanical effect of fast walking post-stroke varied across individual gait metrics. For participants within the stroke gait behavior cluster, walking faster led to an overall gait pattern more different than neurotypical adults compared to the self-selected speed. This suggests that to potentiate the biomechanical benefits of walking at faster speeds and improve the overall gait pattern post-stroke, gait metrics with smaller speed-dependent changes may need to be specifically targeted within the context of fast walking.
建议在快速速度下进行步态训练，以减少中风后的步行活动受限。快速行走也可能减少中风后的步态运动学障碍。然而，尚不清楚中风后患者与神经典型成年人之间的步态运动学差异是否会在以更快速度行走时减小。
确定与以相似速度行走的神经典型成年人相比，更快速度行走对中风后步态运动学的影响。
我们对 28 名中风后患者和 50 名神经典型成年人在多个速度下在跑步机上行走的数据进行了二次分析。我们评估了速度和组对个体时空和运动学指标的影响，并在自我选择和快速速度下对所有指标进行了 k-均值聚类。
中风后患者减小了步长不对称和拖曳腿角度的损伤，在快速速度下减小了组间差异。与组间差异相比，峰值摆动膝关节屈曲、髋关节提升和时间不对称性的速度依赖性变化加剧。我们的聚类分析揭示了两个聚类。一个代表神经典型的步态行为，由神经典型和中风后患者组成。另一个特征是中风步态行为，完全由下肢 Fugl-Meyer 评分低于神经典型步态行为聚类中风后患者的中风后患者组成。在两个速度下，聚类组成基本一致，而聚类之间的距离在快速速度下增加。
中风后快速行走的生物力学影响因个体步态指标而异。对于处于中风步态行为聚类中的参与者，与自我选择速度相比，更快的行走速度导致整体步态模式与神经典型成年人更加不同。这表明，为了增强快速行走的生物力学益处并改善中风后的整体步态模式，可能需要在快速行走的背景下针对具有较小速度依赖性变化的步态指标进行具体靶向治疗。
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