Department of Neurorehabilitation, Kio University, Nara, Japan; Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan.
Department of Physical Therapy, School of Health Science, Nihon Fukushi University, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
Gait Posture. 2023 Jun;103:203-209. doi: 10.1016/j.gaitpost.2023.05.022. Epub 2023 May 23.
Stroke patients have difficulty walking in outdoor environments, including uneven surfaces, reducing their opportunities for social participation. Changes in stroke patients' gait while walking on even surfaces have been reported; however, gait alterations on uneven surfaces remain unclear.
To what extent do biomechanical parameters and muscle activity during even and uneven surface walking differ between stroke patients and healthy people?
Twenty stroke patients and 20 age-matched healthy people walked on a 6 m even and uneven surfaces. Data on gait speed, root mean square (RMS) of trunk acceleration as a measure of gait stability, maximum joint angle, average muscle activity, and muscle activity time were quantified using accelerometers attached to the trunk, video camera images, and electromyography of lower extremities. A two-factor mixed-model analysis of variance was used to test the effects of group, surface, and group × surface interactions.
Gait speed decreased (p < 0.001) on the uneven surface in stroke patients and healthy people. RMS showed an interaction (p < 0.001), and the post-hoc test revealed an increase in stroke patients in the mediolateral direction during the swing phase on the uneven surface. The hip extension angle during the stance phase showed an interaction (p = 0.023), and the post-hoc test revealed a decrease in stroke patients on the uneven surface. The soleus muscle activity time showed an interaction during the swing phase (p = 0.041), and the post-hoc test revealed an increase in stroke patients compared to healthy people only on the uneven surface.
While walking on an uneven surface, stroke patients showed decreased gait stability, decreased hip extension angle during stance phase, and increased ankle plantar flexor activity time during swing phase. These changes may result from impaired motor control and compensatory strategies used by stroke patients on uneven surfaces.
脑卒中患者在户外环境中行走存在困难，包括不平整表面，这减少了他们参与社交的机会。已报道脑卒中患者在平坦表面行走时步态发生变化；然而，在不平整表面上的步态改变仍不清楚。
脑卒中患者和平常人在平坦和不平整表面行走时，生物力学参数和肌肉活动有何不同？
20 名脑卒中患者和 20 名年龄匹配的健康人在 6 米长的平坦和不平整表面上行走。使用附着在躯干上的加速度计、视频摄像机图像和下肢肌电图，量化了步态速度、躯干加速度均方根（RMS）作为步态稳定性的衡量标准、最大关节角度、平均肌肉活动和肌肉活动时间。采用两因素混合模型方差分析检验组、表面和组-表面交互作用的影响。
脑卒中患者和健康人在不平整表面上的步态速度均降低（p<0.001）。RMS 显示出交互作用（p<0.001），事后检验显示在不平整表面的摆动相脑卒中患者在横向方向上增加。站立相的髋关节伸展角度显示出交互作用（p=0.023），事后检验显示在不平整表面上脑卒中患者减少。摆动相的比目鱼肌活动时间显示出交互作用（p=0.041），事后检验显示仅在不平整表面上脑卒中患者比健康人增加。
在不平整表面行走时，脑卒中患者表现出步态稳定性降低、站立相髋关节伸展角度减小以及摆动相踝关节跖屈肌活动时间增加。这些变化可能是由于脑卒中患者在不平整表面上运动控制受损和使用代偿策略所致。
