帕金森病跌倒与非跌倒者平衡评估及步态分析结果比较

目的:探讨帕金森病跌倒与非跌倒者平衡评估及步态分析结果差异,为康复治疗提供临床依据。方法:将帕金森病患者32例,据其是否有跌倒史分为跌倒组15例和非跌倒组17例,比较2组平衡评估及步态分析各项参数结果差异。结果:同非跌倒组比较,跌倒组患者平均/最大轨迹误差更大、单足支撑时间更短、摆动相踝背屈角度更小(P0.05)。结论:帕金森病康复训练中应强调本体感觉、肌力、单侧下肢负重、步态方面的训练,以降低患者跌倒风险。     

Physical function as a prognostic biomarker among cancer survivors

Background:

We tested the hypothesis that objectively measured physical function predicts mortality among cancer survivors.

Methods:

We assessed objectively measured physical function including the short physical performance battery (SPPB) and fast walk speed in older adult cancer survivors.

Results:

Among 413 cancer survivors, 315 (76%) died during a median follow-up of 11.0 years. In multivariable-adjusted analyses, each 1-unit increase in the SPPB score and 0.1 m s⁻¹ increase in fast walk speed predicted a 12% reduction in mortality (hazard ratio (HR): 0.88 (95% confidence interval (CI): 0.82–0.94); P<0.001, and HR: 0.88 (95% CI: 0.82–0.96); P=0.003, respectively).

Conclusions:

Objectively measured physical function may predict mortality among cancer survivors.     

Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations

Introduction: Older adults with mobility limitations are at greater risk for aging-related declines in physical function. Line dancing is a popular form of exercise that can be modified, and is thus feasible for older adults with mobility limitations.

Purpose: The purpose of this study was to assess the effects of 8 weeks of line dancing on balance, muscle strength, lower extremity function, endurance, gait speed, and perceived mobility limitations.

Methods: An experimental design randomly assigned older adults to either an 8-week line dancing or usual care group. The convenience sample consisted of 23 participants with mobility limitations (age range: 65–93?years). The intervention used simple routines from novice line dance classes. At baseline and at 8 weeks, balance, knee muscle strength, lower extremity function, endurance, gait speed, and mobility limitations were measured. ANCOVA tests were conducted on each dependent variable to assess the effects of the intervention over time.

Results: Results found significant positive differences for the intervention group in lower extremity function (p?p?gait speed (p?p?Conclusions: Eight weeks of line dancing significantly improved physical function and reduced self-reported mobility limitations in these individuals. Line dancing could be recommended by clinicians as a potential adjunct therapy that addresses mobility limitations.

• Implications for Rehabilitation

• Line dancing may be an alternative exercise for older adults who need modifications due to mobility limitations.

• Line dancing incorporates cognitive and motor control.

• Line dancing can be performed alone or in a group setting.

• Dancing improves balance which can reduce risk of falls.

     

Pain Management After Bone Reconstruction Surgery Using an Analgesic Bone Cement: A Functional Noninvasive In Vivo Study Using Gait Analysis

Postoperative pain after bone reconstruction is a serious complication that could jeopardize the global success of a surgery. This pain must be controlled and minimized during the first 3 to 4 postoperative days to prevent it from becoming chronic. In this study, a critical-size bone defect was created at the femoral distal end of rats and filled by an injectable calcium phosphate cement (CPC) loaded or not with local anesthetics (bupivacaine or ropivacaine). A functional evaluation of the gait was performed using the CatWalk system to compare the postoperative pain relief enhanced by the different CPCs after such a bone filling surgery. The results demonstrated significant pain relief during the short-term postoperative period, as shown by the print area and intensity parameters of the operated paw. At 24hours, the print area decreased by 65%, 42%, and 24%, and the intensity decreased by 25%, 9%, and 1% for unloaded, ropivacaine-loaded, and bupivacaine-loaded CPCs, respectively, compared with the preoperative values. Bupivacaine-loaded CPC provided an earlier return to full functional recovery than ropivacaine-loaded CPC. Moreover, the CPCs retained their biologic and mechanical properties. For all these reasons, anesthetic-loaded CPCs could be part of the global pain management protocol after bone reconstruction surgery such as iliac crest bone grafting procedures.

Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study

Purpose: Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy.

Materials and methods: Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3?D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6?weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4?weeks later.

Results: Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK.

Conclusion: Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period.

• Implications for Rehabilitation

• Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK).

• The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study.

• The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy.

• Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.

     

Quantitative assessment of knee extensor thrust,flexed-knee gait,insufficient knee flexion during the swing phase,and medial whip in hemiplegia using three-dimensional treadmill gait analysis

Background: Most people with hemiplegia experience gait changes after a stroke. Abnormal gait patterns in stroke patients vary across subjects and this make it difficult to assess the cause of gait abnormalities. Therefore, it is necessary to quantitatively evaluate abnormal gait patterns through gait analysis for stroke patients.

Objective: To develop and evaluate the validity of quantitative assessments of the degree of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip.

Methods: Forty-six healthy control subjects and 112 people with hemiplegia participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern (knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip) with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the four abnormal gait patterns exhibited by the patients was calculated from the three-dimensional coordinate data. The indices were developed based on the definition of the abnormal gait patterns. The index values for the patients were compared with those of healthy subjects as well as with the results of observational gait assessment by three physical therapists with expertise in gait analysis.

Results: Strong correlation was observed between the index value and the median observational rating for all four abnormal gait patterns (?0.64 to ?0.86). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects.

Conclusions: The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周后使用三维步态分析仪器检测并获得两组患者的步态参数。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。