正常成人步态特征研究

目的 研究不同年龄段正常成人的步态特征。方法正常成人90名，分为20～39岁组、40～59岁组、60～70岁组，每组各30名。应用基于数字视频和图像处理的步态分析系统进行步态分析，得到时夺参数、运动学参数。比较3组被试的步态参数差异，对步速与其他步态参数进行Pearson相关性分析，以判定影响步速的相关因素。结果 3组正常成人的部分步忿参数之间存在显著性差异，步速与步频、跨步长／身高、跨步周期、站立相时间、迈步相髋关节、膝关节最大屈曲角度有明娃相关性。结论 应用基于数字视频和图像处理的步态分析系统建立的国内不同年龄段正常成人步态的运动学特征模型，可供临床步态分析参考使用。     

步行双任务对健康老年人和青年人足廓清功能的影响

摘要 目的：观察步行双任务对健康青年人和健康老年人足廓清功能的影响,为减少可能的绊倒风险提供依据。 方法：老年组（健康老年人）25例,青年组（健康青年人）21例,使用三维运动分析系统收集和建模分析软件分析两组受试者在单、双任务步行过程中的时空参数和运动学参数,比较优势侧腿足廓清时的步态参数变化及其变异性。 结果：在单、双任务步行对比中,两组受试者最小趾间距（MTC）未发生明显改变（P>0.05）,但老年组和青年组跨步长时间均明显增加,步速减慢（P<0.05）。老年组双任务时从足趾离地到MTC对应时刻的时间占整个步态周期时间百分比（nMTC-TIME）缩短（P<0.05）,但青年组双任务时此参数未发生明显变化。步态各参数变异性在单、双任务间均无显著性差异（P>0.05）。两组间各参数注意力消耗比较也无显著性差异（P>0.05）。 结论：步行双任务中健康老年人和青年人均进行步态调整,包括增加跨步长时间,减慢步速。老年人虽然表现与健康青年人类似的MTC和步态变异性,但可能为保证此高度,即有效的足廓清采取相应的调整策略,尤其是缩短足廓清阶段,这可能是其预防绊倒的策略之一。     

脑卒中患者躯体运动偏瘫模式的三维运动学评价

目的：通过对脑卒中患者躯体运动的三维运动学分析,定量分析偏瘫步态躯体运动的三维运动学特征,确定客观反映脑卒中后偏瘫步态运动学特征的量化指标。方法：选择首次脑卒中后可以独立步行10m以上的慢性单侧偏瘫患者30例为实验组,正常对照组选择具有正常步行能力的健康老人20例。采用三维步态分析系统进行运动学参数检测与分析。结果：实验组与正常对照组运动学参数比较显示,脑卒中患者骨盆前后倾斜度和骨盆旋转度、身体重心侧方运动和垂直运动范围与正常人群比较差异均有显著性意义（P<0.01）。结论：脑卒中偏瘫步态躯体运动的运动学特征：①身体重心大范围的侧方运动和小范围的垂直运动;②骨盆大范围的前后倾斜运动和旋转运动。     

三维步态分析在截肢患者康复中的应用

采用Vicon三维步态分析系统对健康人和穿戴假肢的下肢截肢患者进行步态分析,表明该系统可提供运动学参数和生物力学参数的变化,由此分析假肢穿戴者与健康人各关节运动的差异。将三维步态分析应用于截肢患者康复方面是切实可行的。     

轻中度帕金森病患者狭窄通道行走的步态特征研究

摘要 目的：分析轻中度帕金森病患者狭窄通道行走时的三维步态参数特征。 方法：选取36例H-Y分期1—3期的轻中度帕金森病患者,36例健康受试者作为对照,分别测量在正常通道和狭窄通道通行时的三维步态参数。对两种路径通行时患者和健康受试者的时空参数、运动学参数及力学参数进行分析。 结果：轻中度帕金森病患者在正常通道和狭窄通道两种不同路径下通行时,运动学参数均没有显著差异（P>0.05）,时空参数中步长、步速、摆动相、单支撑相无显著差异（P>0.05）,而与正常通道相比,患者在通过狭窄通道时的步频变快（P<0.05）,双支撑相延长（P<0.05）,跨步时间变短（P<0.05）。力学参数表现为狭窄通道行走时的地面反作用力矢状轴第二峰值较正常行走增大（P<0.05）,其它方向地面反作用力无显著差异。而健康人群各个参数均无显著差异（P>0.05）。 结论：轻中度帕金森病患者在狭窄通道行走时步态时空学和动力学参数发生改变,步行稳定性及应对复杂环境的能力下降。     

约束手臂摆动对健康青年人步态时空参数的影响

目的:明确约束手臂摆动对健康青年人步态时空参数的影响,探讨手臂摆动在步行中的作用。方法:选取健康青年人36例,其中男性18例,女性18例,平均年龄(22.72±3.54)岁,平均身高(167.35±9.15)cm,平均体重(63.62±16.29)kg。利用Gait Watch三维步态分析系统采集受试者在自然步态、双臂体侧、双臂体前、双臂体后、左臂体侧、左臂体前、左臂体后、右臂体侧、右臂体前、右臂体后共10种状态下的步态时空参数。不同约束状态均随机进行测试。分析不同约束手臂状态下步态时空参数同自然步态之间的差异。结果:不同手臂约束摆动状态下,步态周期、步频、步幅、步速、左步长、右步长、双支撑相同自然步态相比差异无显著性意义(P0.05)。左臂体侧、左臂体前、左臂体后三种约束条件下左支撑相、左摆动相同自然步态相比差异有显著性意义(P0.05);左臂体后、右臂体侧、右臂体前、右臂体后四种手臂约束条件下右支撑相、右摆动相与自然步态相比差异有显著性意义(P0.05)。结论:约束左侧手臂摆动后左下肢支撑相时间缩短,摆动相时间延长;约束右侧手臂摆动后右下肢支撑相时间延长,摆动相时间缩短。     

基于步态轮廓评分分析青年慢性非特异性腰痛患者的步态模式

目的 通过研究步态轮廓评分（GPS）和运动分析剖面图（MAP）来量化青年慢性非特异性腰痛（chronic nonspecific low back pain, CNLBP）患者和健康青年人步态周期中的运动学变化。 方法 采用3D光学运动捕捉系统（Qualisys,Gothenburg,Sweden）采集CNLBP组和健康组受试者各11例的步态运动学数据,将其导入索尔福德大学Richard Baker教授编写的Excel文件并计算出GPS和MAP分数,并进行统计学分析。 结果 右膝关节膝关节屈曲和伸展GVS值CNLBP组为（5.66±1.83）°,健康组为（3.64±1.13）°,组间比较,差异有统计学意义（P＜0.01）,2组受试者其余各项GVS变量和GPS组间比较,差异均无统计学意义（P>0.05）。 结论 青年CNLBP患者存在步态异常,GPS和MAP在青年CNLBP患者的步态评估中具有一定的适用性。     

模拟上肢截肢者走跑步态特征研究

目的：探讨上肢截肢者基本运动的步态特征与正常人步态特征的差异，进一步阐明上肢运动在人体基本运动中的作用机制。方法：实验中采用Motion analysis system红外自动跟踪捕捉系统和Kistler Force Plate进行同步运动学和动力学测试。通过对正常人的手臂进行限制约束，对上肢截肢者进行模拟实验。结果：通过对手臂约束前后对比分析发现约束前后部分步态参数存在显著差异。结论：在行走时步态参数差异较小，跑动时差异较显著；补偿运动主要发生在躯干、骨盆、摆动腿；慢走时摆臂有利于增大垂直方向的作用力，快跑时没有手臂的摆动在脚着地时向后的阻力增大。     

亨廷顿舞蹈症步态空间-时间参数特征及其与统一亨廷顿病等级量表评分的相关性研究

摘要 目的：采用三维运动学分析系统定量评价亨廷顿舞蹈症患者的步态空间-时间参数特征和步行能力,并与统一亨廷顿病等级量表（UHDRS）评分进行相关分析,确定客观评价亨廷顿病患者步态特征的量化指标。 方法：选择可以独立步行10m以上的亨廷顿舞蹈症患者6例为实验组,正常配对健康志愿者6例为对照组,采用远红外线三维步态分析系统进行空间-时间参数检测与分析,实验组还进行UHDRS评分。 结果：实验组与健康对照组空间-时间参数比较,显示亨廷顿病患者最大步速和步频明显下降,而步时不对称指数增加,差异均有显著性意义（P＜0.05）;亨廷顿病患者UHDRS评分与步速、步时不对称指数和跨步长相关,具有显著差异（P＜0.05）。 结论：亨廷顿舞蹈症患者的步态主要表现时间参数异常：步行速度减慢和步频降低为特征的运动徐缓,伴有明显的步时不对称性;UHDRS评分结果与步行能力和步时不对称指数显著相关。     

便携式步态分析与实验室步态分析时空参数的一致性研究

目的 探讨便携式步态分析与实验室步态分析时空参数的一致性.方法 选取15例健康青年人,在同一天内分别进行便携式步态分析(Gait Watch步态分析)和实验室步态分析(Motion Analysis三维运动分析),记录其步频、步幅、步速、步长等时空参数,采用组内相关系数(ICC)、Bland-Altman散点图等方法评定两种步态分析的一致性及差异.结果 便携式步态分析两次测量所得的时空参数之间比较,差异无统计学意义(P＞0.05);便携式步态分析两次测量所得时空参数的ICC均较高,为0.80～0.98,重测信度好.通过Bland-Altman法一致性检验,两种步态分析所得时空参数间的一致性较好,且步幅、步速、左步长、右步长间的差异具有统计学意义(P＜0.05),超过了最小可测变化(MDC)(步幅=0.05 m、步速=0.12 m/s、左步长=0.03 m、右步长=0.04 m).结论便携式步态分析与实验室步态分析所得步频、步幅、步速、步长等时空参数的一致性较好,在临床步态评估中均具有重要意义.     

Gender differences in three dimensional gait analysis data from 98 healthy Korean adults

OBJECTIVES: The research hypothesis was that healthy adults would walk differently according to their gender when walked barefoot at their comfortable speed. The aim of this study was to prove the hypothesis in healthy Korean adults. DESIGN: Between-gender statistical comparisons of the gait analysis data including spatiotemporal, three-dimensional joint kinematic and kinetic data. BACKGROUND: There have been few attempts to identify the significant gender differences in gait pattern and to explore their possible causes. METHODS: Healthy 98 Korean adults (47 females and 51 males) volunteered. Gait analysis data was obtained with opto-electric system and force plates. Normalization was used to avoid the body size effect. Gender difference was tested with independent t-test, ancova, and two-way repeated anova. RESULTS: Females were shorter, both in height and leg length ( P < 0.05 ). The cadence and pelvic width were as great as in males. They walked slower than males due to shorter stride length ( P < 0.05 ). The females had still shorter stride length and narrower step width ( P < 0.05 ), and they walked as fast as the males. Females walked with their pelvis tilted more anteriorly and more up and down oblique motion, hip joints more flexed-adducted-internally rotated, knee joint in more valgus angles ( P = 0.05 ). CONCLUSIONS: The gait analysis data had significant gender differences. We assume that the difference is due to gender features of the gait-related anatomy and habits. Comparison with other research shows some evidence for racial differences.     

Mechanisms of compensation in the gait of patients with drop foot

BackgroundDrop foot is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, but identifying compensation mechanisms remains challenging.MethodsIn order to identify compensatory mechanisms in patients with drop foot, this study evaluated a sample of 15 such patients using a computerized gait analysis system, as compared to a group of 15 healthy subjects.FindingsFour classes of parameters were distinguished, falling in differing intervals of percentage differences between the groups in the study. The first class comprised two kinematic parameters for which the values of percentage differences in the control group were more than 100% greater than for the patient group. The second class comprised two kinetic parameters falling in the interval of 100–49%. In the third class, in the 49–20% interval the main differences were observed for spatiotemporal parameters, whereas in the 20–4% interval the differences were distributed similarly for kinematic, kinetic and spatiotemporal parameters.InterpretationThese differences in gait pattern between the groups may be related to both primary motor deficits and secondary compensatory mechanisms. Generally, we conclude that drop foot affects the patients' overall kinematic and kinetic gait parameters, with compensation seen as a chain originating from a change of movement within the ankle joint.     

Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches

Background

This investigation characterized the time-history pattern of the free moment (FM) during walking and, additionally, assessed whether walking with either an internally or externally rotated foot position altered the FM's time-history.

Methods

Force plate and foot kinematic data were acquired simultaneously for 11 healthy subjects (6 males, 5 females) while walking at their self-selected comfortable speed in 3 foot rotation conditions (normal, internal and external). The FM was calculated and normalized by the product of each participant's body weight and height prior to extraction of peak FM, occurrence of peak FM in stance and net relative impulse. Differences in these values across foot rotation conditions were assessed using separate one-way, repeated measures analysis of variance and subsequent pair-wise comparisons.

Results

The average FM pattern during normal walking exhibits a biphasic shape: resisting inward rotation during approximately the first half of stance and outward rotation during the latter part of stance. While no differences in peak FM or net relative impulse were observed between the internal foot rotation condition and normal walking, the external foot rotation condition resulted in significantly greater peak FM and relative net impulse in comparison to normal walking.

Conclusion

The differences in selected FM variables between normal walking and the external foot rotation condition are attributable to individual subject response to walking with an externally rotated foot. In this condition, some subjects displayed a FM pattern that was similar to that recorded during normal walking, while others displayed markedly larger FM patterns that are comparable in magnitude to those reported for running. The larger FM values in these latter subjects are speculated to be a result of excessive transverse plane body movements. Whilst further investigation is warranted regarding the FM time-history characteristics during walking, our results indicate that the FM may provide useful information in assessment of gait.     

Gender differences exist in osteoarthritic gait

BACKGROUND: Knee osteoarthritis is 2-3 times more prevalent in females than males. Biomechanical differences in gait may play a role in this gender predisposition. The purpose of this study was to determine if there are gender-based biomechanical differences in the gait patterns of people with knee osteoarthritis. METHODS: Three-dimensional gait analysis was performed on healthy (18 males and 24 females) subjects and patients with moderate knee osteoarthritis (24 males and 15 females). Kinematics and kinetics at the hip, knee and ankle were calculated. Variables including anthropometrics, stride characteristics, strength, pain, stiffness, function and radiographic disease severity were also quantified. Multivariate statistical techniques and analysis of variance were used to test for main disease effects, main gender effects and disease vs. gender interactions. FINDINGS: A significant interaction effect between gender and disease was found in the knee flexion angle and the knee moments in the sagittal, frontal and transverse planes. In each of these measures the females exhibited different biomechanics with osteoarthritis, while the osteoarthritic males maintained the same biomechanics as healthy males. This interaction between gender and osteoarthritis was not associated with differences in anthropometrics, stride characteristics, strength, pain, stiffness, function or radiographic disease severity between the populations. INTERPRETATION: This study has found gait pattern differences between the genders in the osteoarthritic patients that were not apparent in the healthy subjects. This suggests that the biomechanics associated with knee osteoarthritis are gender dependent. Therefore, gender specific design of biomechanical interventions to slow the progression of osteoarthritis should be explored.     

Differences in normal and perturbed walking kinematics between male and female athletes

OBJECTIVE: To identify differences in lower extremity kinematic movement patterns between genders during walking through the application of an expected perturbation. DESIGN: Randomized limb kinematics were compared between healthy active males and females. BACKGROUND: Lower extremity kinematics during jump landing and cutting have been implicated as a potential source of the discrepancy in anterior cruciate ligament injury rates between genders. Kinematic differences between genders have been identified during tasks that are not provocative of anterior cruciate ligament injury but do result in increased ligament strain. Repetition of movement patterns that increase anterior cruciate ligament strain may increase the likelihood they will be reproduced during athletic tasks that produce force loads that exceed anterior cruciate ligament tensile strength. METHODS: Twenty subjects (10 women, 10 men) classified as a level I or II athlete underwent motion analyses while performing self-paced walking trials. Five trials were undisturbed, and five each with a platform translating either laterally or anteriorly at heel contact. Sagittal, frontal, and transverse hip angles as well as sagittal and frontal knee angles were collected during stance. RESULTS: Excursions in the frontal and transverse planes were greater at the hip and knee for females compared to males in each walking condition. The rate of these excursions also occurred more rapidly for females than males. There was no difference for joint angles at initial contact between genders, and there was no difference in the amount of sagittal plane excursion for the hip and knee when comparing genders. CONCLUSIONS: Females demonstrate characteristics during both normal and perturbed gait that may potentially contribute to increased anterior cruciate ligament strain. Repetition of these potentially harmful movement patterns during provocative athletic maneuvers may lead to anterior cruciate ligament injury. RELEVANCE: Females exhibit lower extremity kinematic patterns that differ from males. Female kinematic patterns may contribute to an increased risk for anterior cruciate ligament injury.     

Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics

The estimation of patients gait in the field of rehabilitation is the starting point for an appropirate therapy decision and convenient prosthesis or orthosis choice. The measurement and estimation of human locomotion is increasingly being transferred to every day clinical use. In recent times many systems are intended for kinematic gait parameters measurements: stroboscopic photography, movie camera, TV picture analysis, TV signal analysis, chronocyclographical measurement, polarised light goniometer, the "Selspot" system, parallelgram goniometers, exoskeleton goniometers. In the paper the role of the computer in gait measurements is also determined. The problems of the choice of parameters to be measured, unique reference coordinate systems and normal gait pattern are encountered in this work. Finally two versions of pathological gait pattern estimation are described: clinical gait analysis and mathematical quantitative gait analysis. A combination of both methods provides an efficient, compact automatic pathological gait pattern diagnostics.     

Aging and Time-Domain and Spectral Turbulence Parameters of Signal-Averaged Electrocardiograms

The effect of age on the time-domain and spectral parameters of the signal-averaged ECG (SAECG) is not known. In this study we recorded SAECGs from 138 normal healthy subjects (84 females and 54 males) aged between 7 and 102 years. The recordings were processed in time-domain and by spectral turbulence analysis. Spearman correlation coefficients were used to assess the relationship among each of the parameters obtained and age in the total population and in the subpopulations of males and females. Linear regression models of individual parameters with age were calculated and compared in males and females. Using conventional diagnostic criteria, 13 recordings (9.4%) were abnormal in time-domain analysis and 13 (9.4%) were abnormal in spectral turbulence analysis. However, no recording was abnormal in both types of analysis, and the incidence of abnormal SAECG was not age dependent. There were significant correlations between age and 4 of the 5 parameters used to evaluate spectral turbulence analysis (low segment correlation ratio [LSCR], intersegment correlation mean, intersegment standard deviation, and spectral entropy [SE]). However, there was no systematic significant correlation between age and time-domain parameters. The values of tQRS, mean peaks per slice, LSCR, and SE indices were significantly higher in males than in females, irrespective of age. The study concludes that with increasing age, there is a tendency for the parameters of spectral turbulence analysis to become abnormal, possibly reflecting an increase in conduction abnormalities with age.     

脑卒中患者步行能力与下肢三维运动学及动力学相关性分析

目的:通过对脑卒中偏瘫患者下肢三维运动学和动力学的分析,寻找偏瘫患者步态特点,比较分析步行能力与运动学和动力学之间的关系,从运动力学角度探讨偏瘫患者异常步行的原因,寻找康复治疗中需解决的关键问题。方法:选择首次脑卒中后可以独立步行10m以上的右侧偏瘫患者20例为实验组,正常健康中老年人16例为对照组。采用Vicon和AMTOR6-7进行三维步态运动学和动力学检测和分析。结果:实验组与正常对照组比较,脑卒中患者与健康中老年人在步频、跨步时间、双腿支撑时间、步时、离地比率、步长、跨步长和步速同侧比较差异有显著性意义(P<0.05),患侧离地占步态周期百分比和健侧单腿支撑时间实验组与对照组比较差异有显著性意义(P<0.05)。矢状面上同侧髋关节伸展角度、膝关节屈曲角度和踝关节背伸及跖屈角度比较差异都有显著性意义(P<0.05)。同侧髋关节屈伸力矩、同侧膝关节伸直力矩和患侧踝关节背伸力矩实验组和对照组相比差异有显著性意义(P<0.05),步行能力(步速)与患侧髋关节伸展、健侧膝关节屈曲、双侧膝关节伸展、双侧踝关节背伸和跖屈角度相关,均有显著性意义(P<0.05);同时也和双侧髋关节屈伸、膝关节伸展和踝关节背伸力矩相关(P<0.01)。结论:①步长是脑卒中偏瘫患者步态异常的重要参考指数;②髋关节和膝关节伸展,踝关节背伸和跖屈是步态异常的重要表现;③下肢髋关节和膝关节屈伸肌群和踝关节背伸肌群的力量是影响步行能力的重要因素。     

Gait parameters and stride-to-stride variability during familiarization to walking on a split-belt treadmill

Background

Subjects unfamiliar to walking on a split-belt treadmill may initially demonstrate an altered gait pattern or increased variability of gait parameters. While previous investigations have examined kinematic variables associated with familiarization time, the objective of this study was to determine the familiarization period required to obtain the most reproducible gait pattern through the assessment of kinetic, kinematic and spatio-temporal parameters during a single session of treadmill walking.

Methods

Eleven healthy subjects participated in a single bout of treadmill walking which lasted 9 min. Kinematic and kinetic data were collected from the first 30 s of each minute, beginning when the treadmill reached full speed. Means and standard deviations for knee flexion at heel strike, ground reaction forces, step width and step length were obtained to examine the changes in each variable over the 9 min. Mean r² values were evaluated for changes in variability from one stride to the subsequent stride for sagittal plane hip, knee and ankle joint angles and moments, as well as for vertical and horizontal ground reaction forces.

Findings

Significant reductions in variability were found for vertical and horizontal ground reaction forces, knee flexion at heel strike and step length over 9 min. Only step width showed a change in the mean value across trials. There were no increases in r² values after the 5th min for any of the gait variables.

Interpretation

The results suggest that in order to collect accurate data for gait analysis, subjects should be familiarized to the split-belt treadmill for at least 5 min prior to data collection.