From the Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, Ohio (SML, MH, FB, NN); Cleveland Clinic, Department of Biomedical Engineering, Cleveland, Ohio (SML, MMK, JLA); Youngstown State University, Youngstown, Ohio (SML, KL); Cleveland State University, Cleveland, Ohio (DE); Cleveland Clinic, Concussion Center, Cleveland, Ohio (MS, SD, JLA); and Cleveland Clinic, Center for Neurologic Restoration, Cleveland, Ohio (JLA).
Am J Phys Med Rehabil. 2023 Jul 1;102(7):619-624. doi: 10.1097/PHM.0000000000002248. Epub 2023 Mar 26.
Task-specific gait training is recommended to improve locomotor function after stroke. Our objective was to determine the effects of a forced-rate aerobic exercise intervention on gait velocity and biomechanics in the absence of task-specific gait training. Individuals with chronic stroke ( N = 14) underwent 24 sessions of forced-rate aerobic exercise, at a targeted aerobic intensity of 60%-80% of their heart rate reserve. Change in comfortable walking speed in addition to spatiotemporal, kinematic, and kinetic variables were measured using three-dimensional motion capture. Overground walking capacity was measured by the 6-min walk test. To determine gait biomechanics associated with increased walking speed, spatiotemporal, kinematic, and kinetic variables were analyzed separately for those who met the minimal clinically important difference for change in gait velocity compared with those who did not. Participants demonstrated a significant increase in gait velocity from 0.61 to 0.70 m/sec ( P = 0.004) and 6-min walk test distance from 272.1 to 325.1 meters ( P < 0.001). Those who met the minimal clinically important difference for change in gait velocity demonstrated significantly greater improvements in spatiotemporal parameters ( P = 0.041), ground reaction forces ( P = 0.047), and power generation ( P = 0.007) compared with those who did not. Improvements in gait velocity were accompanied by normalization of gait biomechanics.
专项步态训练被推荐用于改善脑卒中后的运动功能。我们的目的是确定在没有专项步态训练的情况下,强制速率有氧运动干预对步态速度和生物力学的影响。14 名慢性脑卒中患者接受了 24 次强制速率有氧运动,目标有氧运动强度为心率储备的 60%-80%。使用三维运动捕捉测量舒适步行速度的变化以及时空、运动学和动力学变量。通过 6 分钟步行测试测量地面行走能力。为了确定与步行速度增加相关的步态生物力学,对那些达到步态速度变化的最小临床重要差异与那些未达到最小临床重要差异的患者分别分析时空、运动学和动力学变量。与治疗前相比,参与者的步态速度从 0.61 米/秒增加到 0.70 米/秒(P=0.004),6 分钟步行测试距离从 272.1 米增加到 325.1 米(P<0.001)。与那些未达到步态速度变化的最小临床重要差异的患者相比,达到最小临床重要差异的患者在时空参数(P=0.041)、地面反作用力(P=0.047)和功率生成(P=0.007)方面的改善更显著。步态速度的改善伴随着步态生物力学的正常化。