节律性听觉注意刺激对帕金森病患者步态的影响

目的 探讨节律性听觉注意刺激对帕金森病患者步态的影响.方法 8例帕金森病患者(帕金森病组)和6名健康对照受试者(对照组)参与本研究.要求受试者完成以下2种条件下的步行:一是让受试者以自己感觉最舒适的速度自由步行2 min,二是要求受试者注意聆听频率高于基线步频10%的节拍器的声音(即加载节律性听觉注意刺激)且按此节律步行.采用三维运动分析仪记录受试者2种条件下的步态参数,使用额叶功能评定量表和Stroop-3测试评估患者的执行能力.结果 节律性听觉注意刺激明显提高了对照组的步频和步速,而帕金森病组步频明显提高,步长和步幅明显减小.在自由步行和加载节律性听觉刺激两种条件下,帕金森病组的步长、步幅和步速均显著低于对照组.听觉刺激减小了对照组的步速变异,增大了帕金森病组的步幅变异.自由步行条件下,2组受试者步态变异系数比较,差异无统计学意义;加载节律性听觉注意刺激后,帕金森病组的步长、步幅和步速变异系数明显高于对照组.执行能力测试显示,帕金森病患者存在执行能力障碍,且Stroop-3的错误率与加载听觉注意刺激条件下的步长呈显著负相关(r=-0.724,P=0.037).结论 外加高于基线步频10%的听觉注意刺激并不会改善帕金森病患者的步态,反而增加了患者的认知负荷.从而加剧步态紊乱,这可能是由于其执行功能障碍所致.

Abstract：

Objective To explore the effects of rhythmic auditory stimulation on the gait of patients with Parkinson's disease(PD). Methods Eight patients with PD and six healthy control subjects were studied.All subjects walked as usaal for 2 min and then Walked for 2 rain with rhythmic auditory attentional stimulation with a frequency 10% faster than their basic pace.The gait parameters in the two walking conditions were measured with three-dimension motion analysis equipment.In addition,executive function was evaluated using a frontal assessment battery (FAB)scale and the Stroop-3 test. Results In both walking conditions,average stride length and velocity were significantly lower in the PD patients than among the controls.The metronome at the higher frequency increased the cadence and stride velocity significantly in the controls.but in the PD patients it was associated with increased ca dence but decreased stride length.With auditory stimulation,the variability of velocity decreased significantly in the controls,but the variability in stride length increased significantly in the PD patients.Even with the auditory stimulation,the variability in step length,stride length and velocity were still significantly higher in the PD patients than among the controls.Executive dysfunction was clearly evident in the PD patients.Stroop-3 error rates were significantly negatively correlated with step length in the condition involving auditory stimulation.Conclusion Auditory attentional stimulation at a higher frequency becomes a new cognitive load for PD patients,and it cannot improve their gait.This may be related to executive dysfunction.     

认知任务干扰脑卒中步态的前驱研究

目的:通过步态分析手段,探讨认知任务对脑卒中患者步态的影响,比较不同认知任务对步态影响的区别。方法:15例脑卒中患者参与本项研究。要求所有患者分别进行两种步行:自然状态下直线步行20m;步行的同时分别执行定向、记忆、计算和言语任务。采用Gaitwatch步态分析系统收集5次步行时的步态参数,包括步频、步幅、步速、双支撑相百分比和健侧摆动相百分比。结果:5组步频无显著性差异(F=1.972,P=0.169),5组步幅(F=13.142,P0.01)、步速(F=11.445,P=0.001)、双支撑相百分比(F=13.142,P0.01)和健侧摆动相百分比(F=11.000,P0.01)有显著性差异。与自然步行相比,4种认知任务时的步幅均显著降低,双支撑相百分比显著提高,定向任务和计算任务时的步速和健侧摆动相百分比显著降低。与计算任务相比,定向任务时的步幅、步速提高,双支撑相百分比降低;记忆任务时步幅、步速和健侧摆动相百分比提高,双支撑相百分比降低;言语任务时步幅和步速提高。结论:认知任务会降低脑卒中患者的步幅、步速和健侧摆动相百分比,延长双支撑相百分比,不同类型认知任务对步态的干扰不同。     

中国正常成人步行时空参数分析

目的:探讨中国正常成人的步行特征,为临床步态分析提供科学参考依据。方法:365名正常受试者,按性别、年龄分为20—29岁组、30—39岁组、40—49岁组、50—59岁组、60—75岁组共10组。应用人体步态垫测量与分析系统,测试受试者自由行走时的步速、步长、步幅、步长时间、摆动时间、支撑时间、单足支撑时间、双足支撑时间等时空参数,并对每位受试者的身高、体重进行测试。结果:年龄组内平均步速,除30—39岁组、60—75岁组外,男性均大于女性(P<0.05),50岁以后,男、女步速均减慢,与50岁以前相比差异具有显著性(P<0.01);各年龄组步长,男性均大于女性(P<0.05),女性步长在50岁以后减小,与50岁以前相比差异具有显著性(P<0.01),男性步长在60岁以后减小,明显小于60岁以前步长(P<0.01)。结论:应用人体步态垫测量与分析系统,首次建立中国正常成人步行时空参数值参考范围,初步揭示中国正常成人的步行时空特征。     

双重任务行走步态分析预测短暂性脑缺血发作患者认知功能障碍的发生

目的 寻找简便易行且敏感、有效地预测短暂性脑缺血发作(TIA)患者认知功能障碍发生的方法,以便及时干预TIA患者认知功能障碍的发生和进展。 方法 选取首次发病,且可独立自主行走的TIA患者36例［蒙特利尔认知评估量表（MoCA）评分不低于26分］,设为TIA患者组;另选取年龄、性别及受教育年限与TIA患者组相匹配的正常受试者36例设为作正常对照组。2组受试者均于入组后当天进行1次双重任务行走步态分析,并于入组12个月后对2组受试者进行MoCA量表评定。采用SPSS 22.0版统计学软件进行数据分析,通过诊断试验验证步态参数预测认知功能障碍的可靠性,并计算接受者操作特性曲线（ROC）下面积。 结果 入组后当天,异常步长的TIA患者的步长变异率分别与正常对照组和非异常步长的TIA患者比较,差异均有统计学意义（P<0.05）;异常平均步速的TIA患者的平均步速分别与正常对照组和非异常平均步速的TIA患者比较,差异均有统计学意义（P<0.05）。入组后当天,正常对照组行双重任务步行时的计算正确率为（90.72±8.72）%,而TIA患者组中异常步态患者和非异常步态组患者的计算正确率均显著低于正常对照组,差异均有统计学意义（P<0.05）,且异常步态患者的计算正确率显著低于非异常步态组患者,差异均有统计学意义（P<0.05）。入组12个月后,异常步态患者中MoCA评分<26分的患者例数与非异常步态患者中MoCA评分<26分的患者例数比较,差异有统计学意义（P<0.01）。计算参数ROC曲线下面积得出,步态参数中的步长变异率和平均步速均可预测12个月后TIA患者认知功能障碍的发生,差异有统计学意义(P<0.01)。 结论 双重任务行走步态分析可有效地预测TIA患者认知功能障碍的发生,较MoCA测试可更早发现异常。     

足底压力训练对脑卒中偏瘫患者步态和步行能力的影响

目的:探讨足底压力训练对脑卒中偏瘫患者步态和步行能力的影响。方法:将60例脑卒中患者按随机数字表法分为足底压力训练组和康复训练组各30例,康复训练组给予Bobath法、运动再学习为主的运动功能训练;足底压力训练组在压力板上进行不同站立姿势以及步行训练,以上治疗每周5次,每次30 min。2组治疗前及治疗3周后采用步行功能分级、GaitWatch三维步态及运动训练系统进行步态分析。结果:治疗3周后,2组步频、步行周期、步幅、步速、步长偏差、双支撑相、步行能力均较治疗前改善(P0.05),且足底压力训练组的步频、步行周期、步幅、步速、双支撑相优于康复训练组(P0.05),但2组间步长偏差、步行能力差异无统计学意义(P0.05)。结论:足底压力训练可提升患者的步行能力,有效改善患者的步态。     

帕金森病患者步态测量与定量分析

摘要 目的：提取帕金森病患者步态运动学和时空参数,通过实验分析找到可以作为步态量化评估的特征参数,为医生提供康复评估的依据。 方法：本文采用基于刚体的虚拟标识点方法在受试者下肢解剖学关键点设置标识点获取其步态信息。受试者被分为开机组(DBS ON),关机组(DBS OFF)和对照组(Control),运动捕捉仪记录受试者多个步态周期的虚拟标识点三维坐标。提取包括关节角度、支撑相比率、双支撑相比率、步态周期时间、步频、步长和步速等在内的步态运动学及时空参数。对三组步态特征参数进行单因素一元方差分析。 结果：各组间下肢各关节角度变化范围、支撑相比率、双支撑相比率、步长和步速差异均有显著性(P<0.01),且随受试者症状的减轻,关节角度变化范围、步长和步速有显著递增趋势 (DBS OFFDBS ON>Control)。 结论：基于刚体的虚拟标识点可以准确测量人体步态。提取出的关节角度变化范围、支撑相比率、双支撑相比率,步长和步速均可作为帕金森病患者康复评估的依据。     

不同脑网络经颅直流电刺激方案对健康成年人步态特征的特异性调控效果研究

目的：基于额顶网络（FPN）、背侧注意网络（DAN）、默认网络（DN）三个步态相关脑网络,制定不同的脑网络经颅直流电刺激（Network t DCS）方案以期实现特异性调控步速和步态变异性、提高步行功能的目的。方法：本研究招募健康成年人,随机分3组,分别接受不同的刺激方案：兴奋FPN抑制DN(FPN+/DN-t DCS)、兴奋DAN抑制DN(DAN+/DN-t DCS)、假刺激（Sham）。在刺激前和刺激后即刻进行常速、快速和双任务条件的步态任务测试。采用双因素重复测量方差分析评估三种刺激方案对不同条件下的步态时空参数和步态变异性的影响。结果：本研究共纳入72例受试者,其中64例完成测试。干预前后常速、快速和双任务步行条件下步态时空参数指标和常速步行条件下步态变异性的改变均无显著交互效应。快速步态任务中,步幅变异性（F=3.671,P=0.031）和双支撑时间变异性（F=3.879,P=0.026）存在显著交互效应;双任务步行条件下,步宽变异性（F=3.940,P=0.025）、步速变异性（F=3.936,P=0.025）和双支撑时间变异性（F=4.913,P=0.011）存在交互效应...     

脑深部电极植入术联合暗示步态训练 改善帕金森患者冻结步态

目的：研究脑深部电极植入术（DBS）联合暗示步行训练对帕金森病（PD）患者冻结步态的改善效果。方法：将符合入选标准的PD患者58例随机分为对照组和干预组,各29例。2组患者均给与常规的抗PD药物治疗和康复训练,干预组在此基础上进行DBS联合暗示步态训练12周。于干预前、后,应用Barthel指数（BI）评定量表和步态时间距离参数变化量表对患者进行评估和比较。结果：干预前,2组的BI评分、步长和步速差异无统计学意义（均P>0.05）;干预后,干预组的BI评分、步长和步速高于同组干预前,且高于对照组（均P<0.05）。结论：DBS联合暗示步态训练,可以增加PD患者的步幅,加快其步速,提高患者日常活动能力,对改善冻结步态有积极的效果。     

步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响

目的:采用步态分析,观察步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响.方法:选择40例符合入选标准的脑卒中后足下垂患者,随机分组到实验组和对照组,均给予常规药物治疗及基本常规康复训练.实验组在此治疗基础上采用给予患侧下肢步态诱发功能性电刺激,根据患者踝关节背伸、内翻程度调节正负电极片位置及具体适应的刺激量30min/次,1次/d,每周6次,共3周.对照组在治疗期间不给予任何电刺激.采用三维步态分析仪器分别于治疗前、治疗3周后检测并获取两组患者步态参数.结果:治疗3周后,两组患者步速、步幅、步频、健侧摆动相均较治疗前明显均提高(P＜0.05),步态周期、步宽、双支撑相、患侧摆动相、健侧支撑相、患侧支撑相均较治疗前显著减小(P＜0.05).组间比较显示,治疗组患者的步行速度、步幅、步频、步行周期、步宽、双支撑相、改善程度均明显优于对照组(P＜0.05).两组患者对称性步态参数治疗前后差异显著,且实验组改善程度显著优于对照组(P＜0.05).结论:步态诱发功能性电刺激治疗能有效改善脑卒中后足下垂患者步速、步频、步行周期等时空参数,提高脑卒中后足下垂患者的步行能力及步态的对称性.     

老年2型糖尿病周围神经病变患者三维步态分析

目的 探讨老年2型糖尿病周围神经病变患者的三维步态分析特点。 方法 选取符合纳入标准的60岁以上的2型糖尿病周围神经病变患者20例（神经病变组）和无周围神经病变的2型糖尿病患者20例（糖尿病组）,并招募年龄相匹配且无2型糖尿病病史的健康志愿者20例（健康对照组）作为研究对象,使用瑞典Qualisys动作捕捉系统对3组受试者进行三维步态测试,采集并分析其步长、步速、步宽、步频、步幅、双足支撑相时间、单足支撑相时间、足底峰值压力及时间等数据特点。 结果 神经病变组的步长、步速、步频、步幅均较糖尿病组和健康对照组下降（P<0.05）;神经病变组与糖尿病组和健康对照组相比较,双足支撑相时间延长,单足支撑相时间缩短,且差异均有统计学意义（P<0.05）;神经病变组足底第一峰值压（P1）和第二峰值压（P2）、第二峰值出现时间（T2）较糖尿病组和健康对照组增加,且差异均有统计学意义（P<0.05）。 结论 老年2型糖尿病周围神经病变患者出现明显步态异常,步行稳定性下降,足底压力增强,足底受压时间增加。     

Does the type of concurrent task affect preferred and cued gait in people with Parkinson's disease?

Difficulty performing more than one task at a time is common in people with Parkinson's disease, resulting in interference with one or both tasks. While studies have shown that greater interference in gait occurs with more complex concurrent tasks, the impact of the type of concurrent task is unclear in the Parkinson's population. Thus the first purpose of this study was to investigate the effect of the concurrent task (calculation, language, or motor) on gait in people with Parkinson's disease. As visual cues are commonly used to aid stride regulation in people with Parkinson's disease, the second purpose of this study was to determine whether this method of increasing stride length was still effective if other tasks were performed simultaneously. Sixteen patients with Parkinson's disease and 16 gender- and age-matched controls performed six cognitive and motor concurrent tasks when seated, walking 10 m, and walking over visual cues. Stride length decreased in people with Parkinson's disease when performing the concurrent calculation and language tasks, but not with the motor task. The language task was more complex than the calculation task, thus the effect was not due to task complexity alone. Visual cues were effective in improving stride length whilst maintaining velocity in people with Parkinson's disease, even when performed under dual task conditions. These findings highlight the importance of the task when assessing and retraining dual tasking during gait, and suggest that retraining dual tasking can occur whilst simultaneously using visual aids to regulate stride length.     

Interference between balance, gait and cognitive task performance among people with stroke living in the community

PURPOSE: To explore differences in cognitive-motor interference between people with stroke and controls when performing functional tasks and to compare dual task performance of stroke fallers and non-fallers. METHOD: Thirty-six people with stroke (mean age 66.5, SD 11.8, mean time since onset 16 months, range 7 - 56) and 24 controls (mean age 62.3, SD 11.61) performed balance and gait tasks in isolation and in conjunction with a cognitive task (remembering a seven item-shopping list). Three-dimensional movement analysis was used to assess anterior posterior (AP) and lateral (ML) sway; 5 m walk time, stride length and velocity. RESULTS: In the single task condition, people with stroke had greater AP sway, reduced velocity and stride length and a longer 5 m walk time than controls (p < 0.01). In the dual task condition, sway reduced and gait slowed in both groups (p < 0.01 for AP sway, stride length, velocity, walk time); only the increase in walk time was greater in people with stroke than in the controls (F = 4.2, p = 0.046). Cognitive performance was maintained during the balance trials but deteriorated during the dual task gait trials in people with stroke (p = 0.017). Similar trends were noted for fallers and non-fallers with stroke: Only group effects for stride length and velocity reached significance (p < 0.05) and only the reduction in stride length was significantly greater among fallers than non-fallers (F = 12.3, p = 0.001). CONCLUSIONS: People with stroke and controls employed similar strategies during the simultaneous performance of simple functional and silent cognitive tasks and maintained postural stability. Increased walk time and decreased cognitive recall were greater for people with stroke and reduced stride length distinguished fallers from non-fallers.     

The effect of cognitive dual tasks on balance during walking in physically fit elderly people

OBJECTIVE: To evaluate the effect on balance of 3 different cognitive dual tasks performed while walking without and with standardization for gait velocity, and measured with both foot placements and trunk movements. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: Fifty-nine physically fit elderly people (mean age, 73.5y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stride length and time variability measured with an electronic walkway, body sway measured with an angular velocity instrument, and gait velocity. RESULTS: Overall, dual tasks resulted in decreased gait velocity (1.46 to 1.23m/s, P<.001), increased stride length (1.4% to 2.6%), and time variability (1.3% to 2.3%) (P<.001), and had no significant effect on body sway. After standardization for gait velocity, the dual tasks were associated with increased body sway (111% to 216% of values during walking without dual task, P<.001) and increased stride length and time variability (41% to 223% increase, P<.001). CONCLUSIONS: In physically fit elderly people, cognitive dual tasks influence balance control during walking directly as well as indirectly through decreased gait velocity. Dual tasks increase stride variability with both mechanisms, but the increase in body sway is only visible after standardization for gait velocity. The decreased gait velocity can be a strategy with which to maintain balance during walking in more difficult circumstances.     

Age-related differences in dual task walking: a cross sectional study

Background  

Variability in stride velocity during walking characterizes gait instability and predicts falling in older individuals. Walking while executing a cognitive task is also associated with increased risk of falling, particularly in older adults. Variability in stride velocity, particularly during dual task walking conditions, may differ between younger and older individuals. The purpose of this study was to examine whether gait velocity and variability in stride velocity differ between older community-dwelling women and younger women during dual task walking.     

Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer’s disease: simple versus dual task: a preliminary report

Background/Aims: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer’s disease (AD) patients. Methods: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20‐second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. Results: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. Conclusion: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.     

Interference between balance,gait and cognitive task performance among people with stroke living in the community

Purpose. To explore differences in cognitive-motor interference between people with stroke and controls when performing functional tasks and to compare dual task performance of stroke fallers and non-fallers.

Method. Thirty-six people with stroke (mean age 66.5, SD 11.8, mean time since onset 16 months, range 7 – 56) and 24 controls (mean age 62.3, SD 11.61) performed balance and gait tasks in isolation and in conjunction with a cognitive task (remembering a seven item-shopping list). Three-dimensional movement analysis was used to assess anterior posterior (AP) and lateral (ML) sway; 5 m walk time, stride length and velocity.

Results. In the single task condition, people with stroke had greater AP sway, reduced velocity and stride length and a longer 5 m walk time than controls (p < 0.01). In the dual task condition, sway reduced and gait slowed in both groups (p < 0.01 for AP sway, stride length, velocity, walk time); only the increase in walk time was greater in people with stroke than in the controls (F = 4.2, p = 0.046). Cognitive performance was maintained during the balance trials but deteriorated during the dual task gait trials in people with stroke (p = 0.017). Similar trends were noted for fallers and non-fallers with stroke: Only group effects for stride length and velocity reached significance (p < 0.05) and only the reduction in stride length was significantly greater among fallers than non-fallers (F = 12.3, p = 0.001).

Conclusions. People with stroke and controls employed similar strategies during the simultaneous performance of simple functional and silent cognitive tasks and maintained postural stability. Increased walk time and decreased cognitive recall were greater for people with stroke and reduced stride length distinguished fallers from non-fallers.     

Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis

Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords “quantitative gait” OR “gait analysis” AND “dementia” AND “single-task” AND “dual-task,” and for “quantitative gait” OR “gait analysis” AND “dementia” AND “fall risk” on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.     

Age-related changes in spatial and temporal gait variables

OBJECTIVE: To extend recent findings describing the effect of age on spatial and temporal gait variables. DESIGN: Experimental. SETTING: A gait analysis laboratory. PARTICIPANTS: Two experiments with healthy nonfallers were conducted. Experiment 1 included 33 subjects (n = 15, 72.13 +/- 3.96yr; n = 18, 25.06 +/- 4.02yr); and experiment 2 included 24 subjects (n = 14, 75.57 +/- 6.15yr; n = 10; 28.10 +/- 3.48yr). INTERVENTIONS: The effect of age, walking velocity, shoe condition, and performance of an attention-splitting task on gait variables was investigated. MAIN OUTCOME MEASURES: Temporal and spatial gait variables were quantified using an instrumented surface across which subjects walked. The independent variables were walking velocity variability, stride length variability, stride width variability, and stride time variability. RESULTS: Stride width variability of older adults was significantly larger than that of younger adults in both experiments. The remaining gait variables demonstrated nonsystematic or no age-related differences. CONCLUSIONS: With the exception of stride width variability, the variability of the remaining gait variables of interest were insensitive to the speed at which subjects walked, whether the subjects were wearing shoes or not, and performing an attention-splitting task while walking. These findings contribute to an emerging interpretive framework established by similar work published by others regarding gait variability.     

Detection of gait instability using the center of mass and center of pressure inclination angles

OBJECTIVE: To define a parameter that quantifies balance control during gait and better identifies elderly people who are at a higher risk of falling. DESIGN: Controlled study. SETTING: University research laboratory. PARTICIPANTS: Twelve elderly patients (mean age, 76.9+/-6y) with complaints of imbalance during walking, or with a history of falls, and 12 matched healthy elderly adults. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Temporal-distance gait parameters (gait velocity, stride length, step width); and sagittal and frontal center of mass (COM) and center of pressure (COP) inclination angles. RESULTS: Elderly patients demonstrated a significantly greater medial, but a significantly smaller anterior, inclination angle than their matched controls during both unobstructed and obstructed gait. The medial COM-COP inclination angle was not affected by the gait velocity in the healthy elderly. When the 2 groups were compared at a similar gait velocity ( approximately 1m/s), the elderly patients still had a significantly greater medial COM-COP inclination angle than did the controls. CONCLUSIONS: Instantaneous COM-COP inclination angles during walking provide information about the ability to control COM position in relation to the corresponding COP. The medial COM-COP inclination angle may be a sensitive measure of gait stability in the elderly.