Department of Neurosurgery, Medical College of Wisconsin, USA.
Department of Physical Therapy, Marquette University, USA.
Gait Posture. 2024 Mar;109:303-310. doi: 10.1016/j.gaitpost.2024.02.014. Epub 2024 Feb 22.
People with degenerative cervical myelopathy are known to have impaired standing balance and walking abilities, but less is known about balance responses during walking.
The aim of this project was to assess reactive balance impairments during walking in people with degenerative cervical myelopathy (PwDCM). We hypothesized that center of mass motion following perturbations would be larger in PwDCM and gluteus medius electromyographic amplitude responses would be decreased in PwDCM.
Reactive balance responses were quantified during unanticipated lateral pulls to the waist while treadmill walking. Walking biomechanics data were collected from 10 PwDCM (F=6) and 10 non-myelopathic controls (F=7) using an 8 camera Vicon System (Vicon MX T-Series). Electromyography was collected from lower limb muscles. Participants walked on an instrumented treadmill and received lateral pulls at random intervals and in randomized direction at 5% and 2.5% body mass. Participants walked at 3 prescribed foot placements to control for effects of the size of base of support.
As compared with controls, the perturbation-related positional change of the center of mass motion (ΔCOM) was increased in PwDCM (p=0.001) with similar changes in foot placement (p>0.05). Change in gluteus medius electromyography, however, was less in PwDCM than in controls (p<0.001).
After experimentally controlling step width, people with mild-to-moderate degenerative cervical myelopathy at least 3 months following cervical spine surgery have impaired reactive balance during walking likely coupled with reduced gluteus medius electromyographic responses. Rehabilitation programs focusing on reactive balance and power are likely necessary for this population.
患有退行性颈脊髓病的人已知其站立平衡和行走能力受损，但对行走时的平衡反应知之甚少。
本项目旨在评估退行性颈脊髓病患者（PwDCM）行走时的反应性平衡障碍。我们假设，在 PwDCM 中，质心运动在受到干扰后会更大，而臀中肌肌电图幅度反应会降低。
在意外向腰部施加侧向拉力时，通过跑步机行走来量化反应性平衡反应。使用 8 个摄像机 Vicon 系统（Vicon MX T-Series）从 10 名 PwDCM（F=6）和 10 名非脊髓病对照组（F=7）中收集行走生物力学数据。采集下肢肌肉的肌电图。参与者在带仪器的跑步机上行走，并以 5%和 2.5%的体重随机间隔和随机方向接受侧向拉力。参与者以 3 种规定的脚步放置行走，以控制支撑基础大小的影响。
与对照组相比，PwDCM 的质心运动（COM）的位置变化与干扰有关（ΔCOM）增加（p=0.001），但脚步放置的变化相似（p>0.05）。然而，臀中肌肌电图的变化却小于对照组（p<0.001）。
在实验控制步宽后，至少在颈椎手术后 3 个月患有轻度至中度退行性颈脊髓病的人在行走时平衡反应受损，可能伴有臀中肌肌电图反应降低。针对这一人群，有必要开展针对反应性平衡和力量的康复计划。
