Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil -
Eur J Phys Rehabil Med. 2023 Apr;59(2):145-151. doi: 10.23736/S1973-9087.23.07687-6. Epub 2023 Mar 20.
Improving walking capacity, in order to achieve community ambulation, is an important goal for both patients and rehabilitation professionals. However, only about 7 to 27% of the stroke survivors will be able to walk in the community.
The aim of this study was to determine which measures of motor impairments would impair community ambulation in 90 individuals with chronic stroke.
Cross-sectional study.
Research laboratory at Federal University of Minas Gerais.
Chronic stroke patients.
For this exploratory study, the dependent variable, community ambulation, was determined by the distance covered during the 6-Minute Walking Test (6MWT). Participants, who covered ≥288 meters during the 6MWT, were classified as unlimited-community ambulators, whereas those who covered <288 meters were considered limited-community ambulators. Logistic regression analysis was carried-out to investigate which measures of motor impairments (deficits in strength of the knee extensor muscles, dynamic balance, and lower-limb motor coordination, as well as increased tonus of the ankle plantarflexor muscles) would explain the variance in community ambulation, i.e., the distance covered during the 6MWT.
Out of the 90 participants, 51 were unlimited and 39 were limited-community ambulators. Only the measure of dynamic balance (OR=0.81, 95% CI: 0.72-0.91) reached significance and was kept in the logistic regression model.
Deficits in dynamic balance best explained limitations in community ambulation in individuals with chronic stroke. Future studies are needed to determine whether rehabilitation interventions aiming at improving dynamic balance would lead to unlimited-community ambulation.
Amongst common motor impairments observed after stroke, such as increased tonus of the ankle plantarflexor muscles and deficits in strength of the knee extensor muscles and lower-limb motor coordination, dynamic balance, was the only variable that explained limitations in community ambulation after stroke. Future studies aiming at investigating community ambulation after stroke could take into account measures of dynamic balance.
提高步行能力，实现社区行走，是患者和康复专业人员的重要目标。然而，只有大约 7%至 27%的脑卒中幸存者能够在社区中行走。
本研究旨在确定 90 名慢性脑卒中患者的哪些运动障碍指标会影响其社区行走能力。
横断面研究。
米纳斯吉拉斯联邦大学的研究实验室。
慢性脑卒中患者。
在这项探索性研究中，依赖变量，即社区行走能力，通过 6 分钟步行测试（6MWT）所覆盖的距离来确定。在 6MWT 中覆盖≥288 米的参与者被归类为无限制社区行走者，而覆盖<288 米的参与者则被归类为有限制社区行走者。进行逻辑回归分析，以研究哪些运动障碍指标（膝关节伸肌力量缺陷、动态平衡、下肢运动协调能力以及踝关节跖屈肌张力增加）可以解释社区行走能力的差异，即 6MWT 所覆盖的距离。
在 90 名参与者中，51 名是无限制社区行走者，39 名是有限制社区行走者。只有动态平衡的测量（OR=0.81，95%CI：0.72-0.91）达到显著水平，并保留在逻辑回归模型中。
动态平衡缺陷最能解释慢性脑卒中患者社区行走受限的原因。未来的研究需要确定旨在改善动态平衡的康复干预措施是否会导致无限制的社区行走。
在脑卒中后常见的运动障碍中，如踝关节跖屈肌张力增加、膝关节伸肌力量缺陷和下肢运动协调能力缺陷，动态平衡是唯一能解释脑卒中后社区行走受限的变量。未来旨在研究脑卒中后社区行走的研究可以考虑动态平衡的测量。
