Nagai Atsushi, Marumoto Kohei, Ohata Kota, Takasaki Shoma, Moriyama Hideki
Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Shingucho 1-8-7-1, Koto, Tatsuno, Hyogo 679-5165, Japan; Department of Rehabilitation Science, Graduate School of Health Science, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo 654-0142, Japan.
Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Shingucho 1-8-7-1, Koto, Tatsuno, Hyogo 679-5165, Japan.
Gait Posture. 2025 Mar;117:109-114. doi: 10.1016/j.gaitpost.2024.12.015. Epub 2024 Dec 12.
Freezing of gait (FOG) during gait initiation in patients with Parkinson's disease (PD) is associated with anticipatory postural adjustments (APAs) with diminishing amplitude, leading to a risk of falls. Assistance with ankle dorsiflexion function by external devices improve APAs during gait initiation, however, the effect of training to improve ankle dorsiflexion function on APAs during gait initiation is unclear.
Does ankle dorsiflexion training improve APAs and FOG during gait initiation in patients with PD?
This 4-week prospective controlled trial included 30 patients with PD, who were divided into two groups: the control group, which received only conventional inpatient rehabilitation, and the intervention group, which received ankle dorsiflexion training in addition to inpatient rehabilitation. Ankle dorsiflexion training consisted of strengthening ankle dorsiflexion muscles and transferring weight backwards while standing. The primary outcomes were displacement of the center of pressure (COP) and electromyography of the tibialis anterior muscle during gait initiation as APAs. The secondary outcome was the New freezing of gait questionnaire (NFOGQ) to determine the severity of FOG. We analyzed differences in treatment effects between groups and within groups.
In the intervention group, the anteroposterior component of COP displacement and muscle activity of the tibialis anterior muscle increased significantly and NFOGQ decreased after the intervention. After intervention, the anteroposterior component of COP displacement showed a significant intervention effect.
Ankle dorsiflexion training for patients with PD improves APAs and FOG during gait initiation and may reduce the risk of falls.
帕金森病（PD）患者在步态起始时出现的冻结步态（FOG）与预期姿势调整（APAs）幅度减小有关，从而导致跌倒风险增加。外部设备辅助踝关节背屈功能可改善步态起始时的APAs，然而，训练改善踝关节背屈功能对步态起始时APAs的影响尚不清楚。
踝关节背屈训练能否改善PD患者步态起始时的APAs和FOG？
这项为期4周的前瞻性对照试验纳入了30例PD患者，分为两组：对照组仅接受常规住院康复治疗，干预组除住院康复外还接受踝关节背屈训练。踝关节背屈训练包括强化踝关节背屈肌肉和站立时向后转移体重。主要结局指标为步态起始时作为APAs的压力中心（COP）位移和胫骨前肌肌电图。次要结局指标是用于确定FOG严重程度的新冻结步态问卷（NFOGQ）。我们分析了组间和组内治疗效果的差异。
干预组干预后COP位移的前后分量和胫骨前肌的肌肉活动显著增加，NFOGQ降低。干预后，COP位移的前后分量显示出显著的干预效果。
对PD患者进行踝关节背屈训练可改善步态起始时的APAs和FOG，并可能降低跌倒风险。
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