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1.
Catarina O Sousa José A Barela Christiane L Prado-Medeiros Tania F Salvini Ana MF Barela 《Journal of neuroengineering and rehabilitation》2011,8(1):48
Background
It is not yet established if the use of body weight support (BWS) systems for gait training is effective per se or if it is the combination of BWS and treadmill that improves the locomotion of individuals with gait impairment. This study investigated the effects of gait training on ground level with partial BWS in individuals with stroke during overground walking with no BWS.Methods
Twelve individuals with chronic stroke (53.17 ± 7.52 years old) participated of a gait training program with BWS during overground walking, and were evaluated before and after the gait training period. In both evaluations, individuals were videotaped walking at a self-selected comfortable speed with no BWS. Measurements were obtained for mean walking speed, step length, stride length and speed, toe-clearance, durations of total double stance and single-limb support, and minimum and maximum foot, shank, thigh, and trunk segmental angles.Results
After gait training, individuals walked faster, with symmetrical steps, longer and faster strides, and increased toe-clearance. Also, they displayed increased rotation of foot, shank, thigh, and trunk segmental angles on both sides of the body. However, the duration of single-limb support remained asymmetrical between each side of the body after gait training.Conclusions
Gait training individuals with chronic stroke with BWS during overground walking improved walking in terms of temporal-spatial parameters and segmental angles. This training strategy might be adopted as a safe, specific and promising strategy for gait rehabilitation after stroke.2.
Taeyou Jung DoKyeong Lee Charalambos Charalambous Konstantinos Vrongistinos 《Archives of physical medicine and rehabilitation》2010,91(1):129-136
Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.
Objective
To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.Design
Comparative gait analysis.Setting
University-based aquatic therapy center.Participants
Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.Interventions
Not applicable.Main Outcome Measures
Spatiotemporal and kinematic gait parameters.Results
The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.Conclusions
The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking. 相似文献3.
Martha L. Walker Stacie I. Ringleb George C. Maihafer Robert Walker Jessica R. Crouch Bonnie Van Lunen Steven Morrison 《Archives of physical medicine and rehabilitation》2010,91(1):115-122
Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.
Objective
To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke.Design
A before-after comparison of a single group with BWSTT intervention.Setting
University research laboratory.Participants
A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study.Intervention
Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback.Main Outcome Measures
Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed.Results
One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s.Conclusions
A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke. 相似文献4.
Kate L. Willoughby Karen J. Dodd Nora Shields Sarah Foley 《Archives of physical medicine and rehabilitation》2010,91(3):333-6
Willoughby KL, Dodd KJ, Shields N, Foley S. Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.
Objective
To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking.Design
Randomized controlled trial.Setting
Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities.Participants
Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10y, 10mo ± 3y, 11mo [range, 5-18y]) completed training and testing.Interventions
Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice.Main Outcome Measures
Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment.Results
The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment.Conclusions
PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP. 相似文献5.
Stefania Fatone Steven A. Gard Bryan S. Malas 《Archives of physical medicine and rehabilitation》2009,90(5):810-818
Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.
Objective
To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.Design
Repeated measures, quasi-experimental study.Setting
Motion analysis laboratory.Participants
Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.Interventions
Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.Main Outcome Measures
Sagittal plane ankle and knee kinematics and kinetics.Results
In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.Conclusions
These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia. 相似文献6.
Metabolic and Mechanical Energy Costs of Reducing Vertical Center of Mass Movement During Gait 总被引:1,自引:0,他引:1
Keith E. Gordon Daniel P. Ferris Arthur D. Kuo 《Archives of physical medicine and rehabilitation》2009,90(1):136-98
Gordon KE, Ferris DP, Kuo AD. Metabolic and mechanical energy costs of reducing vertical center of mass movement during gait.
Objectives
To test the hypothesis that reducing vertical center of mass (COM) displacement will lower the metabolic cost of human walking. To examine changes in joint work associated with increasing and decreasing vertical COM movement during gait.Design
Randomized repeated measures.Setting
Human Neuromechanics Laboratory, University of Michigan.Participants
Able-bodied subjects (N=10).Interventions
Subjects walked at 1.2m/s on a treadmill and overground. Subjects manipulated vertical COM displacement either by adjusting stride length or by using visual feedback to reduce COM movement.Main Outcome Measures
We measured kinematic and kinetic data to calculate vertical and lateral COM displacements, joint torques, and work. In addition, we collected oxygen consumption to calculated metabolic power.Results
Increasing and decreasing vertical COM displacement beyond subjects' preferred range resulted in increases in the metabolic cost of walking. When vertical COM displacement was reduced, corresponding increases in positive ankle and hip work and negative knee work were observed.Conclusions
Humans are capable of walking in a manner that will reduce COM displacement from normal. Decreasing vertical COM movement results in increases in metabolic energy costs because of greater mechanical work performed at the hip, knee, and ankle joints. Thus, reducing vertical COM movement is not a successful strategy for improving either metabolic or mechanical energy economy during normal walking by able-bodied subjects. 相似文献7.
Yea-Ru Yang I.-Hsuan Chen Kwong-Kum Liao Chia-Chi Huang Ray-Yau Wang 《Archives of physical medicine and rehabilitation》2010,91(4):513-328
Yang Y-R, Chen I-H, Liao K-K, Huang C-C, Wang R-Y. Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations.
Objective
To investigate corticomotor changes induced by body weight-supported treadmill training (BWSTT) in patients with short or long poststroke duration.Design
Single-blinded and randomized controlled trial.Setting
Neurologic physical therapy research laboratory.Participants
Hemiparesis patients (N=18) whose motor-evoked potentials could be induced participated in this study. Subjects in each hemiparesis postonset of short (<6mo) or long (>12mo) duration group were randomly assigned to either the control or experimental group.Interventions
Subjects in the experimental groups participated in BWSTT for 4 weeks. Those in the control groups received the general exercise program.Main Outcome Measures
The primary outcomes were motor threshold and map size of the abductor hallucis muscle in the ipsilesional hemisphere. The secondary outcome was Fugl-Meyer Assessment. Outcome measures were blindly assessed before and after completing the 4 weeks of training.Results
The 4-week BWSTT resulted in a decrease of motor threshold and an increase of map size in subjects with hemiparesis of short duration, whereas only the expansion of the map size was noted in subjects with hemiparesis of long duration. Improvement of motor control occurred in subjects with hemiparesis of both short and long duration after BWSTT.Conclusions
The BWSTT results in similar improvement in motor control but different patterns of treatment-induced cortical reorganization in subjects with different poststroke durations. 相似文献8.
Andrew J. Teichtahl Anita E. Wluka Meg E. Morris Susan R. Davis Flavia M. Cicuttini 《Archives of physical medicine and rehabilitation》2009,90(2):320-324
Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The associations between the dominant and nondominant peak external knee adductor moments during gait in healthy subjects: evidence for symmetry.
Objectives
There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults.Design
Cross-sectional study.Setting
Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia.Participants
Three-dimensional Vicon gait analyses were performed for 17 healthy men and women.Interventions
Not applicable.Main Outcome Measures
The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs.Results
Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively.Conclusions
In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally. 相似文献9.
Jaclyn R. Watt Jason R. Franz Keith Jackson Jay Dicharry Patrick O. Riley D. Casey Kerrigan 《Clinical biomechanics (Bristol, Avon)》2010
Background
Instrumented treadmills offer a number of advantages for the biomechanical analysis of elderly gait, yet it is unclear how closely treadmill gait approximates overground gait. Although studies have indicated that the kinematics and kinetics of overground and treadmill gait are very similar in young adults, it still needs to be determined whether data collected in elderly adults during treadmill walking can be generalized to overground gait. The purpose of this study, therefore, was to compare the three-dimensional kinematics and kinetics of treadmill gait to overground gait in a group of healthy elderly subjects.Methods
Three-dimensional kinematic and kinetic data for 18 healthy, nondisabled elderly subjects, age 65–81 years, were collected for speed-matched overground and treadmill walking conditions.Findings
Overall, the kinematics and kinetics of gait during treadmill and overground walking in the elderly had very similar patterns. However, during treadmill walking elderly subjects showed greater cadence, smaller stride length and stride time as well as reductions in the majority of joint angles, moments and powers when compared to overground walking.Interpretation
The large increase in cadence suggests that an effective method of acclimation to treadmill walking still needs to be determined. Because of the differences, we believe that in order for instrumented treadmills to become a suitable tool for research and training purposes in healthy elderly, subjects must be adequately acclimated to the treadmill. 相似文献10.
Stoquart GG Detrembleur C Palumbo S Deltombe T Lejeune TM 《Archives of physical medicine and rehabilitation》2008,89(1):56-61
Stoquart GG, Detrembleur C, Palumbo S, Deltombe T, Lejeune TM. Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study.
Objective
To study the effect of botulinum toxin type A (BTX-A) injection in the rectus femoris on the decreased knee flexion during the swing phase of gait (stiff-knee gait) in people with stroke.Design
Intervention study (before-after trial) with an observational design.Setting
Outpatient rehabilitation clinic and gait laboratory.Participants
Nineteen chronic hemiparetic adults presenting with stiff-knee gait.Intervention
Injection of 200U of BTX-A (Botox) into the rectus femoris.Main Outcome Measures
Before and 2 months after BTX-A rectus femoris injection: Stroke Impairment Assessment Set (SIAS), Duncan-Ely test, and an instrumented gait analysis.Results
Median SIAS score improved from 53 (range, 36−65) to 57 (range, 42−70) (signed-rank test, P=.005) and the Duncan-Ely score from 3 (range, 1−3) to 1 (range, 0−3) (P<.001). In gait analysis, mean (± standard deviation) maximum knee flexion improved from 26°±13° to 31°±14° during the swing phase (paired t test, P<.001), knee flexion speed at toe-off improved from 82°±63° to 112°±75°/s (P=.009), and knee negative joint power (eccentric muscular contraction) improved from −.27±.23 to −.37±.26W/kg (P<.001). The 4 patients who almost did not flex the knee (<10°) before the BTX-A rectus femoris injection did not improve after the injection. The other 14 patients who flexed the knee more than 10° before the BTX-A rectus femoris injection decreased the walking energy cost from 5.4±1.6 to 4.6±1.3J·kg−1·m−1 (P=.006).Conclusions
BTX-A rectus femoris injection may be beneficial in patients with a stiff-knee gait after stroke, particularly in patients with some knee flexion (>10°). 相似文献11.
No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study 总被引:1,自引:0,他引:1
Christina Brogårdh Ulla-Britt Flansbjer Jan Lexell 《Archives of physical medicine and rehabilitation》2010,91(9):1474-1477
Brogårdh C, Flansbjer U-B, Lexell J. No effects of whole-body vibration training on muscle strength and gait performance in people with late effects of polio: a pilot study.
Objective
To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.Design
A case-controlled pilot study with assessments before and after training.Setting
A university hospital rehabilitation department.Participants
People (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55−71y) with clinically and electrophysiologically verified late effects of polio.Interventions
All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°−55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).Main Outcome Measures
Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).Results
All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.Conclusions
This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio. 相似文献12.
Andrysek J Redekop S Matsui NC Kooy J Hubbard S 《Archives of physical medicine and rehabilitation》2008,89(7):1372-1379
Andrysek J, Redekop S, Matsui NC, Kooy J, Hubbard S. A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis.
Objectives
To determine (1) the forces and moments passing through knee-ankle-foot orthoses (KAFOs) during walking and (2) the accuracy with which these loads can be measured using conventional gait analysis techniques.Design
Comparative case series.Setting
Rehabilitation facility with human movement laboratory (gait lab).Participants
Four patients with poliomyelitis wearing KAFOs.Interventions
KAFOs were instrumented with a load cell, and walking data were concurrently collected using conventional gait analysis.Main Outcome Measures
Load measurements and gait parameters.Results
Predominant orthotic loads (knee joint forces and moments) were composed of knee flexion moments and axial compression forces. With conventional gait analysis, peak knee joint moments were substantially underestimated compared with those directly measured using the load cell. Defining the knee axis anatomically versus at the orthotic axis, tracking it dynamically, and compensating for each patient's corrected knee flexion contracture resulted in considerable improvements in the gait lab estimates of knee joint moments.Conclusions
A practical method that directly measures moments and forces in conventional KAFOs has been applied to show that conventional gait analysis techniques substantially underestimate knee joint moments in the KAFOs of persons with poliomyelitis. Underestimation of orthotic loads could result in underdesigned orthotic components and ultimately higher incidence of component failure in clinical applications. 相似文献13.
Rumpa Boonsinsukh Lawan Panichareon Pansiri Phansuwan-Pujito 《Archives of physical medicine and rehabilitation》2009,90(6):919-436
Boonsinsukh R, Panichareon L, Phansuwan-Pujito P. Light touch cue through a cane improves pelvic stability during walking in stroke.
Objective
To examine the effect of a light touch cue provided through a cane on mediolateral (ML) pelvic stability during walking in subjects poststroke.Design
Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods.Setting
Physical therapy clinic, tertiary care center.Participants
Subacute patients (N=40) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days. The average gait speed with a cane was .13m/s (.05-.29m/s).Intervention
Using a cane with the force contact and touch contact methods during walking.Main Outcome Measures
ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration, muscle activation of bilateral tensor fascia latae (TFL), semitendinosus (ST), and vastus medialis (VM) using an electromyography system, and vertical cane force.Results
The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N, respectively. A light touch cue through a cane was required only when the paretic leg accepted the body weight, and this cue can provide ML pelvic stability (.16g of average pelvic acceleration) during walking to the same degree as the force contact method of cane use. However, significant increases in single-limb support duration with higher activations of TFL, VM, and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion (P<.05).Conclusions
A light touch cue can be provided during walking through the use of a cane. This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase. 相似文献14.
Fisher BE Wu AD Salem GJ Song J Lin CH Yip J Cen S Gordon J Jakowec M Petzinger G 《Archives of physical medicine and rehabilitation》2008,89(7):1221-1229
Fisher BE, Wu AD, Salem GJ, Song J, Lin C-H, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.
Objectives
To obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson's disease (PD) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation (TMS).Design
Cohort (prospective), randomized controlled trial.Setting
University-based clinical and research facilities.Participants
Thirty people with PD, within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2.Interventions
Subjects were randomized to high-intensity exercise using body weight-supported treadmill training, low-intensity exercise, or a zero-intensity education group. Subjects in the 2 exercise groups completed 24 exercise sessions over 8 weeks. Subjects in the zero-intensity group completed 6 education classes over 8 weeks.Main Outcome Measures
Unified Parkinson's Disease Rating Scales (UPDRS), biomechanic analysis of self-selected and fast walking and sit-to-stand tasks; corticomotor excitability was assessed with cortical silent period (CSP) durations in response to single-pulse TMS.Results
A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed postexercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in low- and zero-intensity groups. The high-intensity group showed lengthening in CSP.Conclusions
The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD. 相似文献15.
Yiqin Mong Tilda W. Teo Shamay S. Ng 《Archives of physical medicine and rehabilitation》2010,91(3):407-307
Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.
Objectives
To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.Design
Cross-sectional study.Setting
University-based rehabilitation center.Participants
A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.Interventions
Not applicable.Main Outcome Measures
5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.Results
Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.Conclusions
The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke. 相似文献16.
Janssen TW Beltman JM Elich P Koppe PA Konijnenbelt H de Haan A Gerrits KH 《Archives of physical medicine and rehabilitation》2008,89(3):463-469
Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of electric stimulation-assisted cycling training in people with chronic stroke.
Objective
To evaluate whether leg cycling training in subjects with chronic stroke can improve cycling performance, aerobic capacity, muscle strength, and functional performance and to determine if electric stimulation (ES) to the contralateral (paretic) leg during cycling has additional effects over cycling without ES.Design
A randomized controlled trial, with a partial double-blind design.Setting
A rehabilitation center.Participants
Twelve stroke patients (range, 18-70y), more than 5 months poststroke, with lower-extremity hemiparesis.Intervention
Subjects were randomly assigned to groups that performed cycling exercise, one with ES evoking muscle contractions and a control group with ES not evoking muscle contractions. Subjects, blinded for group assignment, trained twice a week for 6 weeks.Main Outcome Measures
Changes in aerobic capacity and maximal power output, functional performance, and lower-limb muscle strength.Results
Aerobic capacity and maximal power output significantly increased by 13.8%±19.1% and 38.1%±19.8%, but muscle strength was not significantly enhanced after training. Functional performance improved (ie, scores on the Berg Balance Scale increased by 6.9%±5.8% (P=.000) and the six-minute walk test improved by 14.5%±14.1% (P=.035). There was no significant effect on the Rivermead Mobility Index (P=.165). Training-induced changes were not significantly different between the 2 groups. Changes in cycling performance and aerobic capacity were not significantly related to changes in functional performance.Conclusions
This study showed that a short cycling training program on a semirecumbent cycle ergometer can markedly improve cycling performance, aerobic capacity, and functional performance of people with chronic stroke. The use of ES had no additional effects in this specific group of subjects with chronic stroke. 相似文献17.
Noel Lythgo Bill Marmaras Helen Connor 《Archives of physical medicine and rehabilitation》2010,91(10):1565-1570
Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.
Objective
To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.Design
Intervention study with crossover design.Setting
University research center.Participants
Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.Intervention
Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).Main Outcome Measures
Physical function, gait, dynamic balance.Results
The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.Conclusions
Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns. 相似文献18.
Age-related differences in Tai Chi gait kinematics and leg muscle electromyography: a pilot study 总被引:1,自引:0,他引:1
Wu G 《Archives of physical medicine and rehabilitation》2008,89(2):351-357
Wu G. Age-related differences in Tai Chi gait kinematics and leg muscle electromyography: a pilot study.
Objective
To compare the biomechanic features of Tai Chi gait by elders with those by young adults, and with those of normative gait.Design
Cross-sectional study.Setting
Laboratory-based testing.Participants
Young (n=6; 3 women) and old (n=6; 5 women) Tai Chi practitioners.Intervention
All subjects had practiced Tai Chi for at least 4 months.Main Outcome Measures
Spatial, temporal, and leg muscle electromyography during Tai Chi gait and normative gait.Results
The primary age-related differences in Tai Chi gait were during single stance, with elders having significantly shorter single-stance time (−50%), less lateral displacement (-30%), knee flexion (-42%), hip flexion (-39%), activation time in the tibialis anterior (-13%), soleus (-39%), and tensor fascia lata (TFL) (-21%), activation magnitude in the tibialis anterior (-39%), and coactivation time of the tibialis anterior and soleus (-47%). Compared with normative gait, elders during Tai Chi gait had significantly larger knee (139%) and hip (66%) flexions, longer duration (90%-170%) and higher magnitude (200%-400%) of the tibialis anterior, rectus femoris, and TFL muscle activities, and longer duration of coactivation of most leg muscle pairs (130%-380%).Conclusions
The elders practice Tai Chi gait in higher posture than younger subjects. The Tai Chi gait poses significantly higher challenges to elder’s balance and muscular system than does their normative gait. 相似文献19.
Background
Comparisons of treadmill and overground walking following stroke indicate that symmetry in temporal-distance measures is better on the treadmill suggestive of better gait economy. We examined this issue by examining the kinematic, kinetic and metabolic demands associated with overground and treadmill walking at matched speeds and also explored the effect of increasing treadmill speed.Methods
Ten people with hemiparesis walked overground at their preferred speed which was matched on the treadmill. Belt speed was then increased 10% and 20% above preferred speed. Temporal-distance outcomes, angular kinematics and vertical ground reaction forces were recorded during steady state (stable heart rate and oxygen uptake).Findings
Step and stance times were longer when walking overground but the degree of symmetry was comparable for both surfaces. In contrast kinematic data revealed significant interlimb asymmetry with respect to all lower limb joint excursions during overground walking accompanied by higher vertical ground reaction forces at push-off. The metabolic demands, however, were lower when walking overground than on the treadmill. Increasing the belt speed increased angular displacements and the vertical forces associated with both limbs such that symmetry remained unchanged. Metabolic demands increased significantly.Interpretation
People with stroke adopt a more symmetrical kinematic walking pattern on the treadmill which is maintained at faster belt speeds. Surprisingly, at matched speed the metabolic cost was significantly higher with treadmill walking. We suggest further research to explore whether an increased reliance on the hip musculature to compensate lower push-off forces could explain the higher the energy cost. 相似文献20.
Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.