脑小血管病患者双重任务行走步态参数的研究

目的 分析老年脑小血管病(cerebral small vessel disease, CSVD)患者单任务行走(STW)和双重任务行走(DTW)步态参数变化,探讨影像学标志物与步态参数的相关性。方法 选择解放军总医院第七医学中心神经内科2020年9月1日～2021年6月1日连续就诊的42例CSVD患者,依据CSVD总评分分为高负荷组16例、中负荷组16例和低负荷组10例。行头颅MRI检查,记录腔隙性脑梗死(LI)和脑微出血(CMB),根据Fazekas量表评分评估脑白质高信号(WMH)。行STW和运动-认知的DTW,记录步速、步频、步长及跨步时间,计算双重任务效应(DTC)。结果 3组DTW时步速、步长、步频和跨步时间比较,差异有统计学意义(P<0.05,P<0.01)。与STW比较,DTW时步速、步频、步长明显降低,跨步时间明显延长(P<0.01)。STW时,CSVD总评分与步速(r=-0.316,P=0.041)、步长(r=-0.309,P=0.046)相关。DTW时,CSVD总评分与步速(r=-0.629,P=0.000)、步频(r=-0.474,P=0.00...     

认知负荷对老年脑小血管病患者书写及绘画流畅性的影响

目的分析认知负荷对老年脑小血管病(cerebral small vessel disease,CSVD)患者书写及绘画流畅性的影响。方法选择2018年11月~2019年5月解放军总医院第七医学中心神经内科就诊的脑白质损害患者59例(CSVD组),同期选择本院年龄、性别相匹配的健康体检者42例(对照组)。应用蓝牙智能笔对受试者进行书写及绘画测试的双重任务,第1任务为书写及绘画测试,第2任务为听辨的认知测试,分别进行单独任务、双重任务及双重任务成本(dual task cost,DTC)测试。结果 CSVD组双重任务书写时间较单独任务书写时间明显延长[(53.76±11.25)s vs(40.29±8.83)s,P<0.01]。CSVS组双重任务书写时间较对照组明显延长[(53.76±11.25)s vs(41.21±8.60)s,P<0.01]。CSVD组双重任务书写听辨和绘画听辨正确个数较单独听辨正确个数明显减少[(12.31±2.36)个vs(13.31±2.61)个,P<0.05;(10.98±1.81)个vs(13.31±2.61)个,P<0.01]。CSVD组双重任务书写听辨和绘画听辨正确个数较对照组明显减少[(12.31±2.36)个vs(13.52±2.97)个,P<0.05;(10.98±1.81)个vs(13.29±3.16)个,P<0.01]。CSVD组双重任务书写时间DTC和绘画听辨正确个数DTC较对照组明显增多,差异有统计学意义(P<0.01)。结论认知负荷下,老年CSVD患者书写流畅性易受到影响。双重任务条件下,更易发现老年CSVD患者上肢运动功能障碍。     

老年脑小血管病患者认知衰弱的临床研究

目的探讨老年脑小血管病(cerebral small vessel disease, CSVD)患者认知衰弱(cognitive frailty, CF)的发病情况。方法收集2018年3月～2019年4月在解放军总医院第七医学中心神经内科住院且诊断CSVD的患者98例,根据患者是否符合CF的诊断标准分为CF组20例(20.41%)和非CF组78例。将同时符合Fried的生理衰弱标准和简易智能状态检查量表(mini-mental state examination, MMSE)中轻度认知功能障碍(MCI)患者为CF。患者行头颅MRI检查,完成双重任务行走(dual task walking, DTW)等认知和运动检查。以Fazekas量表评分评估CSVD负荷情况,低负荷46例、中负荷38例、高负荷14例,用logistic回归分析相关性。结果 CF组患者Fazekas量表评分明显高于非CF组[(2.25±0.64)分vs(1.53±0.66)分,P=0.000],低、中和高负荷患者MCI比例(19.57%vs 50.00%vs 85.71%,P=0.000)和DTW速度[(0.91±0.19)m/s vs(0.80±0.23)m/s vs(0.56±0.20)m/s,P=0.000]比较,均有显著差异。logistic回归分析中,校正年龄、性别、教育、共病等因素后,CF与DTW速度显著负相关(标准化回归系数=-0.580,P=0.006)。结论老年CSVD患者中CF较常见,CF患者存在较高的CSVD负荷状态,CF与DTW密切相关。     

老年脑小血管病患者运动测评的临床研究

目的 分析老年脑小血管病(CSVD)患者仪器化起立-行走计时测试(iTUG)表现。方法 选择2021年9月至2022年3月解放军总医院第七医学中心干部神经内科连续住院的CSVD患者49例,按照Fazekas评分分为重度CSVD组13例(Fazekas评分2～3分),非重度CSVD组36例(Fazekas评分0～1分)。同期另选择健康体检者11例为对照组。记录人口学特征、利用唐顿跌倒风险指数(DFRI)评估被试跌倒风险、传统起立-行走计时测试用时,采集iTUG各项参数,包括时相1用时、时相1摆动幅度、时相2用时、时相2摆动幅度、时相3用时、时相4用时,时相4摆动幅度、时相5用时。结果 与对照组及非重度CSVD组比较,重度CSVD组DFRI评分、时相3用时、时相4用时明显延长[3.00(3.00,6.00)分vs 2.00(1.00,3.00)分、2.00(0.00,4.00)分;(2.8±1.5)s vs(2.0±0.9)s、(2.1±0.6)s;(2.9±1.0)s vs(2.1±1.0)s、(2.4±0.7)s,P<0.05],时相3角速度明显变慢[(1.2±0.4)°/s v...     

基于数字视频和数字图像处理的步态分析在卒中康复训练中的应用

目的研究基于数字视频和数字图像处理的步态分析在卒中患者康复训练中的作用。方法选择一侧肢体偏瘫的卒中患者20例,应用基于数字视频和数字图像处理的步态分析方法,评价康复训练前及训练后3个月双侧肢体的时空参数（跨步周期、跨步长、步频、步速、站立相时间）和髋、膝、踝关节角度参数的变化。结果①20例患者训练前跨步长、步速为（0．51±0．12）m、（0．26±0．17）m／s;训练后为（0．66±0．23）m、（0．33±0．21）m／s,均P〈0．05。跨步周期、步频及站立相时间训练前后差异无统计学意义。②与康复训练前比较,康复训练后患侧肢体踝关节首次着地屈曲角度明显减小;踝、髋关节站立相最大伸展角度增大;足尖离地时膝关节屈曲角度增大,踝关节伸展角度增加;迈步相膝、髋关节最大屈曲角度均增加;矢状面髋关节角度变化范围增大,踝关节角度变化范围减少。健侧肢体康复训练前后,除膝关节迈步相最大屈曲角度增加外（P〈0．05）,其他关节角度参数变化不明显。结论基于数字视频和数字图像处理的步态分析,有助于定量评价卒中患者的步态特征和康复治疗效果。     

抗阻训练在成年脑瘫患者步态功能康复中的应用

目的探讨渐进抗阻训练在改善脑瘫(CP)患者步态功能及行走方面的效果。方法选择44例CP患者[粗大运动功能分级(GMFCS)Ⅰ~Ⅱ级],随机分为训练组及对照组各22例,分别进行12 w的康复训练。训练组进行高负荷、渐进抗阻训练,对照组给予常规康复训练。分析训练前后两组在步态周期、跨步长、步速、踝关节活动度及屈曲角度、6 min步行试验方面的差异。结果训练前后两组步速、6 min步行试验均有所提高,但差异无统计学意义(P>0.05);在步态周期、跨步长、踝关节活动度及屈曲角度方面,训练组改善明显,对照组无明显改善,两组差异有统计学意义(P<0.05)。结论高负荷、渐进抗阻训练改善了患者的步态功能,而在改善患者步行速率方面,抗组训练无明显优势。     

醒脑开窍针刺法结合康复训练干预脑卒中病人步态及平衡功能障碍的临床研究

目的探讨针刺结合康复训练干预脑卒中病人步态及平衡功能障碍的临床效果。方法选取2017年5月—2018年5月郴州市第一人民医院收治的脑卒中病人64例,采用随机序列软件分为对照组和治疗组,每组32例。两组均给予常规内科基础治疗和康复训练;治疗组加用醒脑开窍针刺法治疗。两组病人的步态参数采用步态分析系统评价;平衡能力采用Berg平衡量表和Tinetti平衡与步态量表评价;跌倒风险采用起立行走计时测验(TUGT)和站起测验(CRT)评价。结果两组治疗后步长、步速、步频均较治疗后提高(P<0.05或P<0.01),其中步速提高程度更为明显;两组治疗后摆动相百分比、足廓清和足跟落地角度均较治疗后增加(P<0.05),而支撑相百分比、脚尖离地角度则均较治疗后缩小(P<0.05);与对照组治疗后相比,治疗组对步态参数的改善程度更为明显(P<0.05)。两组治疗后Berg和Tinetti量表评分均较治疗前升高(P<0.05),而TUGT和CRT时间均较治疗前缩短(P<0.05);与对照组治疗后相比,治疗组平衡能力及跌倒风险的改善程度更为明显(P<0.05)。结论醒脑开窍针刺法结合康复训练能改善脑卒中病人的偏态步态,并提高病人平衡能力,从而降低跌倒风险。     

老年脑小血管病患者语言流畅性的网络图分析研究

目的利用网络图分析老年脑小血管病(CSVD)患者词语流畅性测验(VFT)特点。方法选择2018年1～9月解放军总医院第七医学中心神经内科就诊的老年脑白质损害患者30例(CSVD组),另选择年龄与性别匹配的健康体检者30例(对照组),利用SpeechGraphs软件分析VFT,同时收集人口学资料及认知功能测评数据。采用Spearman秩相关分析网络图参数与其他指标的相关性。结果 CSVD组节点数、直径、平均最短路径(ASP)明显低于对照组,密度和平均总等级(ATD)明显高于对照组(P0.05,P0.01)。CSVD组选择反应时间明显高于对照组[(0.53±0.12)s vs (0.46±0.09)s,P=0.004],数字图形转换评分明显低于对照组[(18.70±3.42)分vs (22.60±4.45)分,P=0.000]。相关性分析显示,节点数与选择反应时间、受教育程度及数字图形转换相关;边数量与选择反应时间、受教育程度及数字图形转换相关(P0.01)。直径、ASP与数字图形转换相关;密度与教育程度、选择反应时间和数字图形转换相关;ATD与教育程度和数字图形转换相关(P0.01)。结论 VFT网络图分析发现老年CSVD患者在执行功能方面存在的损害,有助于老年CSVD患者的早期筛查。     

表面肌电触发式功能电刺激踝外翻训练对脑梗死足内翻患者步态的影响

目的 观察利用表面肌电触发式功能电刺激辅助的踝外翻训练对脑梗死后足内翻患者步态的影响。方法 将符合条件的64例脑梗死患者随机分为传统踝外翻训练组(传统组)和表面肌电触发式功能电刺激踝外翻训练组(触发组),每组32例。治疗前和治疗8周后分别进行评定,采用OptoGait进行步态分析,选取步速、步频和步长作为评价指标。使用日本OG GD-601表面肌电触发式功能电刺激仪辅助触发组踝外翻训练。结果 经过8周的康复训练,传统组与触发组的步速、步频、步长均较治疗前显著改善(P<0.05);治疗后触发组的步速、步频、步长改善程度均显著优于传统组(P<0.05)。结论 利用表面肌电触发式功能电刺激辅助的踝外翻训练可以对脑梗死足内翻患者的步速、步频、步长产生积极的作用。     

基于正常行走模式的功能性电刺激对老年脑卒中患者步行功能的影响

目的在常规康复训练基础上,对比基于正常行走模式的功能性电刺激与常规功能性电刺激对老年脑卒中患者步行功能恢复的疗效。方法选择2017年2~10月在山东省立第三医院康复中心进行康复治疗的脑卒中患者36例,随机分为对照组18例和治疗组18例。2组在常规康复治疗基础上,治疗组增加基于行走模式的功能性电刺激训练,30min/次,1次/d,每周6d,对照组采取常规神经肌肉电刺激训练,30min/次,1次/d,每周6d。2组分别在治疗前、治疗3周及6周对步行功能相关参数进行测定,包括Holden步行能力评分、10m步行速度、步行时空相关参数。结果治疗组治疗3周和6周有效率明显高于对照组(94.4%vs 83.3%,P0.05;100.0%vs94.4%,P0.05)。治疗组和对照组治疗3周和6周10m步行速度、步长、步速、步频较治疗前明显增快,步宽较治疗前明显缩窄,差异有统计学意义(P0.05)。治疗组治疗6周10m步行速度、步长、步速、步频较对照组明显增快,步宽较对照组明显缩窄,差异有统计学意义(P0.05)。结论基于正常行走模式的功能性电刺激较常规功能性电刺激更能改善老年脑卒中偏瘫患者的步行能力。     

Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?

BACKGROUND: Limited research exists on fear of falling and its affect on gait parameters. Studies have shown a relationship between fear of falling and restriction of activities. The purpose of this study was to determine if a fear of falling in elderly persons was associated with changes in spatial and temporal gait parameters, independent of a history of falls. It was hypothesized that, in elderly persons, gait changes would be associated with a preexisting fear of falling. METHODS: Ninety-five community-dwelling adults, aged 60-97 years (mean age = 74, standard deviation = 8.5) participated in this study. Participant scores on the Modified Falls Efficacy Scale determined an individual's placement into the "fearful" or "fearless" category. Spatial and temporal gait parameters of speed, stride length, step width, and double limb support time were assessed using the GAITRite system, a computerized electronic walkway. RESULTS: The fearful group had a significantly slower gait speed (p <.05) and shorter stride length (p <.05) when compared to the fearless group. Stride width was significantly longer (p =.05) and double limb support time was significantly prolonged (p <.05) in the fearful participants when measured against the fearless participants. CONCLUSIONS: The results of this study support the hypothesis that fear of falling does influence spatial and temporal gait parameter changes in elderly persons. Slower gait speed, shorter stride length, increased stride width, and prolonged double limb support time were found to be associated with a preexisting fear of falling.     

本体感觉训练对步行能力下降老年患者康复的效果

目的 探讨本体感觉训练对步行能力下降老年患者康复的效果.方法 选取2017年3月至2019年7月在空军军医大学西京医院老年病科住院的68例步行能力下降的老年患者,采用随机数表法分为试验组和对照组,每组34例.对照组采用常规步行能力训练,试验组在常规治疗基础上增加本体感觉训练.比较2组患者治疗前及治疗8周后Holden功...     

Altered gait profile in subjects with peripheral arterial disease

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 +/- 1; mean +/- SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 +/- 1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, double-support time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower (p < 0.001) in the PAD subjects compared with the non-PAD controls (99.9 +/- 3.3 vs. 117.5 +/- 5.3 cm/s) due to an 8% (p = 0.019) slower cadence (99.9 +/- 1.7 vs. 103.3 +/- 2.4 steps/min) and a 14% (p < 0.001) shorter stride length (119.8 +/- 2.9 vs. 135.8 +/- 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase (p = 0.006) and 3% more in stance (p = 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance (p=0.004) and 16% more in double-stance (p = 0.007). Similar results were obtained at the preferred walking pace. In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces.     

Effect of a walking program on gait characteristics in patients with osteoarthritis

This paper reports the results of a study of the gait of 102 patients with osteoarthritis of theknee. Functional status was measured by a 6-min test of walking distance; the stride characteristics associated with the walk test were assessed. Stride characteristics were measured by a StrideAnalyzer. Patients were randomized to an 8-week educational and walking program (the intervention group) or to a weekly telephone survey (the control group). The intervention group patients had a 15% increase in walking distance (P < 0.0001) and increases of 9.1% in stride length at freewalking speeds (P < 0.007) and 17% in stride length at fast walking speeds (P < 0.01) comparedtothe control group. The results of this study have shown that the walking and educational program was effective in improving gait function in patients with osteoarthritis of the knee.     

临床路径对ST段抬高心肌梗死患者急诊冠状 动脉介入术后临床疗效的影响

目的评价临床路径对急性sT段抬高心肌梗死（STEMI）患者介入术后临床疗效的影响。方法随机选择100例STEMI实施急诊冠状动脉介入术临床路径的患者作为观察组,同时随机选择100例同期STEMI未实施急诊冠状动脉介入术（PCI）临床路径的住院患者为对照组。主要终点指标是术后2hST段抬高振幅总和（∑STE）的下降幅度、6min步行试验的距离,次要终点指标是住院病死率。结果观察组患者就诊至球囊扩张（D2B）时间显著短于对照组（中位数,65minUS．95min,P〈0．001）,就诊90min内完成球囊扩张的比例显著高于对照组（98％＇US．65％,P〈0．001）。观察组有89例患者相关导联的ESTE较术前下降〉50％,对照组有69例患者相关导联的∑STE较术前下降〉50％（89％-69％,P〈0．01）。住院第5天,观察组患者行6min步行试验的距离明显较对照组患者步行距离延长[（400．01±336．91）m vs（342．014-16．92）m,P〈0．05）,在PCI后30天行6min步行试验中,观察组患者步行距离明显长于对照组[（421．01±25．19）mVS．（349．17±26．15）m,P〈0．05）。观察组的住院病死率显著低于对照组（2％US．7％,P〈0．01）。结论实施临床路径可显著改善心肌再灌注、提高心脏功能,明显改善患者远期预后。     

高龄脑小血管病患者脑微出血与步态障碍的相关性分析

目的探讨高龄脑小血管病患者脑微出血病灶与步态障碍的关系。方法选择80岁以上军队离退休男性脑小血管病患者232例,通过测量定量步态参数及临床步态量表、脑微出血病灶影像学检查和统计学分析,比较脑微出血病灶数目及部位与步长、步速、步宽等步态特征的相关性。结果脑微出血数目与步长(回归系数=-0.02,P=0.03)、步宽(回归系数=0.21,P=0.04)、Tinetti试验(回归系数=-0.19,P=0.00)及起立行走试验(回归系数=0.02,P=0.02)比较,差异有统计学意义。脑叶和深部微出血灶与步长、步宽呈负相关,与Tinetti试验及站立行走试验的相关性差异有统计学意义(P<0.05,P<0.01)。结论脑微出血作为独立因素和高龄脑小血管病患者的步态障碍有相关性。     

Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed

BACKGROUND: Backward walking is used increasingly in rehabilitation programs to promote balance, strength, and aerobic conditioning. This study examines the effect of movement direction on the temporal-spatial gait characteristics of old versus young adults when progressing at a comfortable pace and as fast as possible. METHODS: Participants included 40 old (mean age 77.7, standard deviation +/- 6.2) and 30 young volunteers (mean age 24.0, standard deviation +/- 2.3), who were independent walkers. Using a computer-based walkway system, participants were requested to walk forward and backward at a normal pace and as fast as possible. Analyses of variance and Tukey-Kramer tests were conducted to determine effects of age, movement direction, and acceleration of gait speed on various gait parameters. RESULTS: Forward and backward walking of elderly persons is generally characterized by a lower velocity, cadence, stride length, and swing phase, accompanied by an increase in the double-support phase. Reversing from forward to backward walking presents a similar pattern in both age groups, with a decrease in gait velocity, stride length, and swing phase, an increase in the double-support phase, and no change in cadence. However, the decrease in stride length is significantly greater among elderly persons. In young persons, higher gait velocities are achieved by concurrent increases in stride length and cadence, regardless of movement direction. Ability of older persons to increase backward ambulation is limited and relies solely on increasing cadence. CONCLUSIONS: Elderly persons demonstrate difficulties in walking backward, with stride length particularly affected. These difficulties must be considered when using backward ambulation for rehabilitation of elderly persons.     

Effect of subjective knee-joint pain on the laterality of knee extension strength and gait in elderly women

This study aimed to examine the effect of subjective knee-joint pain on the laterality of knee extension strength and gait in elderly women. The subjects were 144 elderly women (62-94 years old; mean age 76.2±6.0 years; ±S.D.) who were divided into the following groups: 81 persons without knee-pain (no knee-pain group), 39 persons with the subjective pain in right or left knee (single knee-pain group), and 24 persons with the subjective pain in both knees (double knee-pain group). The subjects took a knee extension strength test and a 12 m maximum effort walk test. Knee extension strength, stance time, swing time, stride length, step length and swing speed were selected as parameters. A significant laterality was found in knee extension strength only in the one knee-pain group. The laterality of gait parameters was not found in all groups. In conclusion, elderly women who can perform daily living activity independently, even though having subjective pain in either knee or laterality in knee extension strength exertion show little laterality of gait during short distance walking.     

Effects of a robotic walking exercise on walking performance in community‐dwelling elderly adults

Background: Reduced gait speed and stride length are characteristic of gait in elderly people and increase their dependency on assistance. We developed a robotic stride assistance system (SAS) to automatically control the walk ratio during walking. Our aim was to quantify the effects of a walking exercise with the SAS on walking performance and glucose metabolism during walking in community‐dwelling elderly adults. Methods: For 3 months, 15 women (72–85 years old) performed the walking exercise twice weekly for 90 min/session. We assessed walking for 5 m at a comfortable speed before and after the intervention. Positron emission tomography with [¹⁸F]fluorodeoxyglucose (FDG) was used to assess muscle activity during an unassisted 50‐min walk. Results: Walking speed was improved by the intervention and FDG uptake by the gluteus minimus, gluteus medius and rectus femoris, and pelvic muscles (iliacus and gluteus muscles) were reduced. Conclusion: These results suggest that a walking intervention program using an applied robotic system is useful for improving the walking ability and the efficiency of muscle activities during walking in the elderly.