运动性疲劳对健康男大学生足底压力分布的影响

目的:分析运动性疲劳对健康男大学生足底压力分布的影响,为科学指导锻炼提供依据。方法:10名普通男大学生沿400米跑道慢跑至中度疲劳,应用0.5米footscan誖USB平板测试系统对受试者运动性疲劳产生前后足底压力分布情况进行测试。结果:与疲劳前相比,运动疲劳后,(1)受试者足跟着地阶段明显变短,足支撑阶段明显变长;(2)左足T2-T5、M2、M4、M5和右足T1、T2-T5、M2、M3、M5、HM、HL各区域与地面的压强峰值显著降低;左足T2-T5区域、右足T1和T2-T5区域与地面压强峰值出现时间显著缩短,而其它部位压强峰值出现时间有延迟趋势;(3)左足T2-T5区域与地面接触时间显著缩短,M2区域显著延长;右足M1、M2、M3区域显著延长;(4)左足T2-T5区域与地面的接触面积显著减小,T1、M3、M5区域显著增大,而其它部位均有增大的趋势;右足除M3显著减小外,其它区域均表现出下降的趋势;(5)左足T2-T5、M5区域和右足M2、M3区域所受压强在时间上的积累(Pt)显著减小;(6)足平衡总体上呈现内外翻程度增大的变化趋势,但10名受试者中有3例疲劳前后的变化不明显。结论:运动性疲劳导致下肢肌肉力量减弱等生理机能下降,从而引起步态分期、足底压力分布参数、足平衡等发生相应变化。     

探戈舞蹈锻炼对有近期跌倒史老年患者平衡能力的影响

目的:观察探戈舞蹈锻炼对有近期跌倒史老年患者平衡能力的影响。方法:舞蹈组为35例有近期跌倒史老年患者,志愿参加探戈舞蹈锻炼,每天活动时间大约80～100min,每周至少坚持5天,4个月为1个学期(疗程)。对照组为37例同龄、同性别参与散步活动者,活动形式为匀速平路步行,活动时间相同,速度在50～70m/min,每周活动频度和疗程与实验组相同。两组对象实验前后分别接受Berg平衡量表(BBS)、单腿支撑时间(OLS)、步速、步长、起立-行走测试(TUGT)和平衡功能测试仪评估。结果:(1)两组对象实验前BBS、OLS、步速、步长和TUGT等指标分布接近(P均>0.05),两组实验后BBS、OLS、步速和步长等指标明显上升,而TUGT则明显下降;与实验后对照组比较,舞蹈组BBS、OLS、步长均显著增加,TUGT显著减少(P均<0.01～0.05)。(2)两组实验后睁眼和闭眼左右摆幅指数和单位面积轨迹长等指标明显上升,而外周面积、矩形面积、总轨迹长、单位轨迹长则明显下降;与实验后对照组比较,舞蹈组睁眼和闭眼左右摆幅指数和闭眼单位面积轨迹长显著增加,而睁眼和闭眼总轨迹长、外周面积以及闭眼单位轨迹长则显著减少(P均<0.01～0.05)。结论:与散步活动比较,探戈舞蹈锻炼改善有近期跌倒史老年患者各项平衡能力指标更为明显。     

凝视手机对青年女性行走时足底压力及下肢表面肌电的影响

目的:探讨凝视手机对青年女性行走时足底压力及下肢表面肌电的影响。方法:运用Footscan高频足底压力测试系统和BTS FREEEMG300型号的32导无线表面肌电系统对16名青年女性正常行走与凝视手机行走进行测量,比较两种状态步行过程中步长、跨步长、步宽,足底各区域压力峰值、接触面积、冲量、足着地过程时相及均方根振幅等指标的变化。结果:青年女性凝视手机行走改变了正常行走步态特征,主要表现在步长变短、步宽变小(P<0.05)、前掌接触阶段和整足接触阶段所占支撑期的百分比增加(P<0.05);低头凝视手机行走时足底第3跖骨、第4跖骨和足跟外侧区域的峰值压力高,与地面接触面积大(P<0.05));与正常行走相比,凝视手机行走足底第3跖骨、第2跖骨、第1跖骨所受冲量较大(P<0.05);凝视手机行走步态周期不同时相的下肢各肌肉参与程度较低。结论:凝视手机行走使用了更为谨慎的步态;凝视手机行走容易导致足底出现疲劳和损伤;凝视手机行走时神经肌肉的控制程度减弱。     

足底振动噪声对老年人平衡能力的影响

目的 通过足底振动噪声刺激,提高老年人足底感觉敏感度,改善其平衡控制能力.方法 采用可调频振子作用于足底,利用三维运动跟踪系统对6名老年人及8名年轻人进行了平衡能力测试和评估,提取4个主要评估参量:移动轨迹总距离、最大前后动摇径、最大左右动摇径和身体移动包络面积.分析了在5种测试条件下老年人立位姿势的变化. 结果加振后4个参量均有减弱趋势,其中3个参量(移动轨迹总距离、最大左右动摇径、身体移动包络面积)有明显差异(P＜0.05),而最大前后动摇径未有明显差异(P＞0.05).不同振动频率对老年人平衡控制能力有着不同的影响.结论 微弱的振动噪声刺激,能够改善老年人平衡控制能力,可以利用在足底增加振动刺激的方法对老年人立位平衡能力进行训练.     

基于足底压力中心和脑肌电相干性特征的人体平衡能力评估方法

目的提出一种基于足底压力中心和脑肌电相干性特征的人体平衡能力评估新方法。方法 10名受试者平衡能力被划分为P1和P2组,进行平衡实验:通过主成分分析法合成足底压力中心信号各传统特征参数,得到足底压力中心信号(COP)综合特征;在分析人体平衡调节过程中脑肌电相干特性的基础上,引入反映人体平衡的脑肌电协调反应新特征;最后将COP综合特征、协调反应特征和脑电、肌电信号的多元多尺度样本熵组成特征向量,使用支持向量机分类器完成人体平衡能力的评估。结果本方法的平衡评估正确率可达72.5%,高于传统的基于COP姿态信号方法。结论人体平衡脑肌电协调反应新特征的加入,显著提高了人体平衡能力分类的正确率。     

躯干控制能力对脑卒中患者平衡功能的影响

目的：探讨躯干控制能力训练对脑卒中患者平衡功能的影响。方法：80例编瘫患者随机分成治疗组和对照组各40例。两组采用常规康复治疗方法。治疗组同时强调躯干控制能力训练,治疗后两组患者分别采用躯干控制能力（Sheikh）评分、FMA平衡功能评分进行比较,比较两组治疗效果。结果：两组治疗前后比较和组间比较差异均有显著性意义（P（0.05）;两组变化均数比较治疗组优于对照组（P（0.001）。结论：躯干控制能力训练对脑卒中患者平衡功能有良好的促进作用。     

呼吸肌训练对脑卒中患者呼吸功能的影响

目的 探讨呼吸肌训练对脑卒中患者呼吸功能的影响.方法 选择脑卒中偏瘫患者52例,用随机数字法分为观察组及对照组,每组26例.对照组进行常规康复训练,观察组除常规康复训练外进行呼吸肌训练.比较两组患者治疗前后动脉血气分析(动脉血pH值、Pa0 2、PaCO2数值),肺通气功能测定(FVC、FEV1、FEV1％、PEF、MVV％数值),随访3个月后肺部感染及再发脑卒中的发生率.结果 治疗后两组患者的PaO2 、PaCO2数值之间,FVC、FEV1、FEV1％、PEF、MVV％数值之间,差异具有显著的统计学意义(P＜0.05);观察组患者的PaO2、PaC0 2数值和FVC、FEV1、FEV1％、PEF、MVV％数值,治疗前后的差异具有统计学意义(P＜0.05);对照组患者的PaO 、PaC0 2数值和FVC、FEV1、FEV1％、PEF、MVV％数值,治疗前后的差异也具有统计学意义(P＜0.05);观察组的改善情况优于对照组.治疗结束后随访3个月,两组患者的肺部感染率之间,存在显著的统计学差异(x2=7.77,P＜0.01),而再发脑卒中发生率比较,两组间差异无统计学意义(P＞0.05).结论 对脑卒中患者进行及时、有效的呼吸肌训练,能有效改善肺通气功能,提高动脉氧分压,降低二氧化碳分压,促进呼吸功能恢复,降低肺部感染率.     

健身气功对中度帕金森病患者心境状态和认知的影响

目的:观察健身气功改善帕金森病患者心境状态及认知的效果。方法:36名中度帕金森病患者随机分为气功锻炼组(18人)和对照组(18人),气功锻炼组进行为期8周、每周5天、每天60 min的健身气功锻炼,对照组保持平常的生活方式不变且不参与健身气功练习。实验前后运用简式心境状态量表(POMS)和蒙特利尔认知评估量表(Mo CA)进行测试。结果:心境状态方面,在疲劳、抑郁、精力、总分这4个维度上,相比于前测,气功锻炼组后测得分显著改善(P<0.05),而对照组前后测得分差异不显著(P>0.05);在紧张、愤怒、慌乱、自我的四个维度上两组前后测差异均不显著。认知功能方面,注意、延迟回忆、认知总分维度,相比于前测,气功锻炼组后测得分显著改善(P<0.05),而对照组前后测得分差异不显著(P>0.05);在视空间与执行能力、命名、语言、抽象、定向维度上两组前后测差异均不显著。结论:健身气功可以改善中度帕金森病患者部分心境状态和部分认知功能。     

Quantitative Evaluation of Gastrocnemius Medialis Stiffness During Passive Stretching Using Shear Wave Elastography in Patients with Parkinson's Disease: A Prospective Preliminary Study

ObjectiveTo prospectively investigate the feasibility of shear wave elastography (SWE) as a new quantitative and objective method for evaluating the stiffness of the gastrocnemius medialis (GM) muscle during passive stretching in patients with Parkinson''s disease (PD).Materials and MethodsSWE of the GM muscle was performed in 28 patients with PD [13 female and 15 male; mean age ± standard deviation (SD): 63.0 ± 8.5 years] and 12 healthy controls (5 female and 7 male; mean age ± SD: 59.3 ± 6.4 years) during passive ankle rotation. A Young''s modulus-ankle angle curve was constructed. The GM slack angle and baseline Young''s modulus (E₀) were compared between the markedly symptomatic and mildly symptomatic sides of patients with PD, and healthy controls. Additionally, the correlation between the GM slack angle and the severity of rigidity, and the observer reproducibility of SWE in determining the GM slack angle were evaluated.ResultsThe GM slack angle was smaller on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of −29.13° ± 3.79° and −25.65° ± 3.39°, respectively, vs. −21.22° ± 3.52°; p < 0.001 and p = 0.006, respectively). Additionally, in patients with PD, the GM slack angle on the markedly symptomatic side was smaller than that on the mildly symptomatic side (p = 0.003). The E₀ value was lower on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of 10.11 ± 2.85 kPa and 10.08 ± 1.88 kPa, respectively, vs. 12.23 ± 1.02 kPa; p = 0.012 and p < 0.001, respectively). However, no significant difference was found between the markedly and mildly symptomatic sides in patients with PD (p = 0.634). A negative linear relationship was observed between the GM slack angle and lower limb rigidity score on the markedly symptomatic side in patients with PD (r = −0.719; p < 0.001). The intraclass correlation coefficients for observer reproducibility of SWE ranged from 0.880 to 0.951.ConclusionThe slack angle determined by SWE may be a useful quantitative and reproducible method for evaluating muscle stiffness in patients with PD.     

Effects of Levodopa on Postural Strategies in Parkinson's disease

Altered postural control and balance are major disabling issues of Parkinson's disease (PD). Static and dynamic posturography have provided insight into PD's postural deficits; however, little is known about impairments in postural coordination. We hypothesized that subjects with PD would show more ankle strategy during quiet stance than healthy control subjects, who would include some hip strategy, and this stiffer postural strategy would increase with disease progression.We quantified postural strategy and sway dispersion with inertial sensors (one placed on the shank and one on the posterior trunk at L5 level) while subjects were standing still with their eyes open. A total of 70 subjects with PD, including a mild group (H&Y≤2, N = 33) and a more severe group (H&Y≥3, N = 37), were assessed while OFF and while ON levodopa medication. We also included a healthy control group (N = 21).Results showed an overall preference of ankle strategy in all groups while maintaining balance. Postural strategy was significantly lower ON compared to OFF medication (indicating more hip strategy), but no effect of disease stage was found. Instead, sway dispersion was significantly larger in ON compared to OFF medication, and significantly larger in the more severe PD group compared to the mild. In addition, increased hip strategy during stance was associated with poorer self-perception of balance.     

Effects of leg muscle fatigue on gait in patients with Parkinson's disease and controls with high and low levels of daily physical activity

Patients with Parkinson's disease (PD) are more susceptible to muscle fatigue, which can damage their gait. Physical activity can improve muscle condition, which is an important aspect during walking. The aim of this study was to analyze the effects of lower limb muscle fatigue on gait in patients with PD and healthy individuals, grouped according to physical activity level. Twenty Patients with PD (PD group) and 20 matched individuals (control group) were distributed according to physical activity level into four subgroups of ten individuals (active and inactive). Participants performed three walking trials before and after lower limb muscle fatigue, induced by a repeated sit-to-stand task on a chair. Kinematic (stride length, width, duration, velocity and percentage of time in double support) and kinetic (propulsive and breaking anterior–posterior and medio-lateral impulse) gait parameters were analyzed. In both groups, participants increased stride length and velocity and decreased stride duration and braking vertical impulse after lower limb muscle fatigue. The PD groups presented higher step width and percentage of double time support than the control groups before muscle fatigue. The control groups increased step width and decreased percentage of time in double support, while the PD groups did not change these parameters. For physical activity level, active individuals presented longer stride length, greater stride velocity, higher braking and propulsive anterior–posterior impulse and shorter step width than inactive individuals. Groups sought more balance and safety after lower limb muscle fatigue. Physical activity level does not appear to modify the effects of lower limb muscle fatigue during unobstructed walking in individuals with PD or controls.     

Metabolic Alterations in Parkinson's Disease after Thalamotomy, as Revealed by 1H MR Spectroscopy

Objective

To determine, using proton magnetic resonance spectroscopy (¹H MRS) whether thalamotomy in patients with Parkinson''s disease gives rise to significant changes in regional brain metabolism.

Materials and Methods

Fifteen patients each underwent stereotactic thalamotomy for the control of medically refractory parkinsonian tremor. Single-voxel ¹H MRS was performed on a 1.5T unit using a STEAM sequence (TR/TM/TE, 2000/14/20 msec), and spectra were obtained from substantia nigra, thalamus and putamen areas, with volumes of interest of 7-8ml, before and after thalamotomy. NAA/Cho, NAA/Cr and Cho/Cr metabolite ratios were calculated from relative peak area measurements, and any changes were recorded and assessed.

Results

In the substantia nigra and thalamus, NAA/Cho ratios were generally low. In the substantia nigra of 80% of patients (12/15) who showed clinical improvement, decreased NAA/Cho ratios were observed in selected voxels after thalamic surgery (p < 0.05). In the thalamus of 67% of such patients (10/15), significant decreases were also noted (p < 0.05).

Conclusion

Our results suggest that the NAA/Cho ratio may be a valuable criterion for the evaluation of Parkinson''s disease patients who show clinical improvement following surgery. By highlighting variations in this ratio, ¹H MRS may help lead to a better understanding of the pathophysiologic processes occurring in those with Parkinson''s disease.     

The transition between turning and sitting in patients with Parkinson's disease: A wearable device detects an unexpected sequence of events

BackgroundWhen older adults turn to sit, about 80% of the subjects complete the turn before starting to sit i.e., a distinct-strategy, while in about 20%, part of the turning and sitting take place concurrently, i.e., an overlapping-strategy. A prolonged duration of the separation between tasks in the distinct-strategy (D-interval) and a prolonged duration of the overlap interval in overlapping-strategy (O-interval) are related to worse motor symptoms and poorer cognition. In the present study, we evaluated what strategy is employed by patients with Parkinson’s disease (PD) when they transition from turning to sitting.Methods96 participants with PD performed turn to sit as part of the Timed Up and Go test, both with and without medications, while wearing a body-fixed sensor. We quantified the turn-to-sit transition and determined which strategy (distinct or overlapping) was employed. We then stratified the cases and used regression models adjusted for age, gender, height, and weight to examine the associations of the D-interval or O-interval with parkinsonian features and cognition.ResultsMost patients (66%) employed the overlapping-strategy, both off and on anti-parkinsonian medications. Longer O-intervals were associated with longer duration of PD, more severe PD motor symptoms, a higher postural-instability-gait-disturbance (PIGD) score, and worse freezing of gait. Longer D-intervals were not associated with disease duration or PD motor symptoms. Neither the D- nor O-intervals were related to cognitive function. Individuals who employed the overlapping-strategy had more severe postural instability (i.e., higher PIGD scores), as compared to those who used the distinct-strategy.SignificanceIn contrast to older adults without PD, most patients with PD utilize the overlapping strategy. Poorer postural and gait control are associated with the strategy choice and with the duration of concurrent performance of turning and sitting. Additional work is needed to further explicate the mechanisms underlying these strategies and their clinical implications.     

自行下体负压训练器锻炼对心血管功能及下体负压耐力的影响

目的 探讨利用自行下体负压训练器锻炼后心血管功能及下体负压耐力的变化,为其应用提供实验依据。方法 12名健康男性被试者随机分为两组,分别在进气阀门完全关闭(A组)、进气阀门打开至峰值负压为-30mmHg(B组)两种状态下进行锻炼。A组锻炼持续时间为5d,3min／d,分别于锻炼前、锻炼3、5d后进行心脏泵血功能及头高位倾斜检查,进行短程心率变异性分析,锻炼前后行下体负压耐力检查。B组锻炼持续时间为10d,5min／d,分别于锻炼前、锻炼5、8、10d后进行各项检查,检查项目与A组相同。结果 A组锻炼后,心脏泵血功能显著降低,下体负压耐力显著升高。B组心脏泵血功能则在锻炼8d后显著增强,下体负压耐力也显著提高。结论 利用自行下体负压训练器进行锻炼。可以显著提高下体负压耐力,但训练方案不同心血管功能的改变也不同。     

Motion analysis of axial rotation and gait stability during turning in people with Parkinson's disease

BackgroundAxial rigidity and postural instability in people with Parkinson's disease (PD) may contribute to turning difficulty. This study examined the rotation of axial segments and gait instability during turning in people with PD.MethodsThirteen PD and twelve age-matched healthy adults were recruited. Participants performed the timed Up-and-Go test and were recorded by a 3D motion capture system. Axial rotation was evaluated by the rotation onset of the head, thorax and pelvis. Gait stability was evaluated by the center of mass and center of pressure inclination angle. Turning performance was evaluated by turning time and turning steps.ResultsDuring turning, PD adults rotated the head, thorax and pelvis simultaneously, whereas healthy adults rotated in a cranial to caudal sequence. Further, PD adults had a smaller sagittal inclination angle (p < 0.001) but larger frontal inclination angle (p = 0.006) than healthy adults. PD adults also turned slower (p = 0.002) with a greater number of steps (p < 0.001) than healthy adults. Last, PD adults showed a significant correlation between the sagittal inclination angle and turning steps (Spearman's ρ = −0.63), while healthy adults showed a significant correlation between frontal inclination angle and turning steps (Spearman's ρ = −0.67).ConclusionThis study demonstrated the axial rigidity in PD adults during turning may reduce forward progression and increase lateral instability. The reduced progression is associated with extra turning steps and the increased lateral instability may result in great fall risk.     

Clinimetric properties of the Tinetti Mobility Test,Four Square Step Test,Activities-specific Balance Confidence Scale,and spatiotemporal gait measures in individuals with Huntington's disease

Background and purposeIndividuals with Huntington's disease (HD) experience balance and gait problems that lead to falls. Clinicians currently have very little information about the reliability and validity of outcome measures to determine the efficacy of interventions that aim to reduce balance and gait impairments in HD. This study examined the reliability and concurrent validity of spatiotemporal gait measures, the Tinetti Mobility Test (TMT), Four Square Step Test (FSST), and Activities-specific Balance Confidence (ABC) Scale in individuals with HD.MethodsParticipants with HD [n = 20; mean age ± SD = 50.9 ± 13.7; 7 male] were tested on spatiotemporal gait measures and the TMT, FSST, and ABC Scale before and after a six week period to determine test–retest reliability and minimal detectable change (MDC) values. Linear relationships between gait and clinical measures were estimated using Pearson's correlation coefficients.ResultsSpatiotemporal gait measures, the TMT total and the FSST showed good to excellent test–retest reliability (ICC > 0.75). MDC values were 0.30 m/s and 0.17 m/s for velocity in forward and backward walking respectively, four points for the TMT, and 3 s for the FSST. The TMT and FSST were highly correlated with most spatiotemporal measures. The ABC Scale demonstrated lower reliability and less concurrent validity than other measures.ConclusionsThe high test–retest reliability over a six week period and concurrent validity between the TMT, FSST, and spatiotemporal gait measures suggest that the TMT and FSST may be useful outcome measures for future intervention studies in ambulatory individuals with HD.     

Sonographic findings of the median nerve and prevalence of carpal tunnel syndrome in patients with Parkinson's disease

PURPOSE: Parkinson's disease (PD) is a chronic progressive disorder which is characterized by rest tremor, akinesia or bradykinesia and rigidity. Carpal tunnel syndrome (CTS) is caused by compression of median nerve and can occur as a result of repetitive trauma. The aim of this study was to estimate the prevalence of CTS in PD and evaluate the median nerve sonographically. MATERIALS AND METHODS: Fifty-three wrist of 29 patients with PD were included in the study according to Hoehn and Yahr (H&Y) clinical stage and divided into two groups. The first group consisted of 29 wrists of patients with mild PD (H&Y stage I-II). The second group consisted of 24 wrists of patients with severe PD (H&Y stage III-IV). Thirty-six wrists of 20 age-matched patients were used as control group. Both of the patients with PD and control group underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained at the level of distal radioulnar joint (level 1) and at the level of pisiform bone in the carpal tunnel (level 2). At each level, the cross-sectional area of the median nerve and flattening ratio were calculated. RESULTS: There was no significant difference for all parameters, except one parameter, between the patients with PD and control group, and also among mild and severe groups of PD and control group (p>0.05). Interestingly, amplitude of median nerve in the second finger was significantly lower in PD patients than control group within normal limits (p=0.010). Of all wrists of PD patients, 13 (24.4%) have been diagnosed as CTS and 7 (19.4%) control wrists had CTS. Median nerve cross-sectional area of CTS patients were more than 10mm(2) in 6 (46%) wrists of PD patients but in only 1 (14%) control wrist at each level. Although it was not statistically significant, there was higher cross-sectional area at each level in patients with severe PD (level 1: 10.43+/-2.30mm(2), level 2: 10.35+/-3.19mm(2)) than patients with mild PD (level 1: 9.93+/-2.61mm(2), level 2: 9.51+/-2.83mm(2)) and control group (level 1: 9.69+/-3.19mm(2), level 2: 9.07+/-3.61mm(2)). CONCLUSION: PD may pose a risk for the development of CTS due to the repetitive movement of tremor. Although sonography is not an ideal method of diagnosis for CTS, it may take our attention for indicating CTS in patients with PD especially in severe ones.