De Vlieger Daan, Defour Arne, Bar-On Lynn, Cambier Dirk, Swinnen Eva, Van der Looven Ruth, Van Bladel Anke
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Rehabilitation Research Group (RERE), Vrije Universiteit Brussel, Laarbeeklaan, Brussel.
PLoS One. 2025 Jan 3;20(1):e0315332. doi: 10.1371/journal.pone.0315332. eCollection 2025.
Increasing one's walking speed is an important goal in post-stroke gait rehabilitation. Insufficient arm swing in people post-stroke might limit their ability to propel the body forward and increase walking speed.
To investigate the speed-dependent changes (and their contributing factors) in the arm swing of persons post-stroke.
Twenty-five persons post-stroke (53±12.1 years; 40.72±43.0 months post-stroke) walked on a treadmill at comfortable (0.83m/s) and fast (1.01m/s) speed. Shoulder and elbow kinematics were compared between conditions using Statistical Parametric Mapping (SPM) analysis, and discrete parameters using a Wilcoxon signed-rank test or an independent sample t-test. The relations between speed-dependent changes in shoulder and elbow range of motion and clinical and gait parameters were assessed using Spearman correlation coefficients.
The non-paretic arm showed expected speed-dependent kinematic adaptations with increases in active range of motion for shoulder flexion (p<0.001), extension (p<0.05), abduction (p = 0.001), rotation (p = 0.004) and elbow flexion (p<0.001). The paretic arm only showed an increase in shoulder abduction and elbow flexion (both p<0.001). Persons post-stroke with a more impaired arm swing coordination pattern only showed speed-dependent adaptations for elbow flexion (p<0.001) at the paretic side during fast walking. In contrast, persons post-stroke with a normal arm swing coordination pattern presented with increases in active range of motion of the shoulder abduction and elbow flexion (both p<0.001) at the paretic side when walking fast. More upper limb impairment (r = -0.521, p<0.01) and a wider step width (r = 0.534, p<0.01) were related to a larger increase in mean elbow flexion during faster walking.
Persons post-stroke show different changes in arm swing kinematics at the paretic compared to the non-paretic side when increasing walking speed. The changes are related to the impairment level and stability during walking, indicating that therapeutic interventions aiming to increase walking speed by improving arm swing might need to target these factors.
提高步行速度是中风后步态康复的一个重要目标。中风患者的手臂摆动不足可能会限制他们推动身体向前和提高步行速度的能力。
研究中风患者手臂摆动中与速度相关的变化（及其影响因素）。
25名中风患者（年龄53±12.1岁；中风后40.72±43.0个月）在跑步机上以舒适速度（0.83米/秒）和快速速度（1.01米/秒）行走。使用统计参数映射（SPM）分析比较不同条件下的肩部和肘部运动学，使用Wilcoxon符号秩检验或独立样本t检验比较离散参数。使用Spearman相关系数评估肩部和肘部运动范围的速度依赖性变化与临床和步态参数之间的关系。
健侧手臂表现出预期的与速度相关的运动学适应性变化，肩部前屈（p<0.001）、后伸（p<0.05）、外展（p = 0.001）、旋转（p = 0.004）和肘部屈曲（p<0.001）的主动运动范围增加。患侧手臂仅表现出肩部外展和肘部屈曲增加（均p<0.001）。手臂摆动协调模式受损更严重的中风患者在快走时仅患侧肘部屈曲表现出与速度相关的适应性变化（p<0.001）。相比之下，手臂摆动协调模式正常的中风患者在快走时患侧肩部外展和肘部屈曲的主动运动范围增加（均p<0.001）。上肢损伤程度越高（r = -0.521，p<0.01）和步幅越宽（r = 0.534，p<0.01）与快走时平均肘部屈曲增加幅度越大相关。
中风患者在提高步行速度时，患侧与健侧手臂摆动运动学变化不同。这些变化与损伤程度和步行稳定性有关，表明旨在通过改善手臂摆动来提高步行速度的治疗干预可能需要针对这些因素。
