放散式体外冲击波对脑卒中患者下肢痉挛及三维步态参数的效果研究

摘要 目的：观察放散式体外冲击波对脑卒中偏瘫患者下肢痉挛,步态时空、对称性参数以及运动学参数的影响。 方法：选取40例符合入选标准的脑卒中偏瘫患者,将其随机分为试验组及对照组,每组20例。试验组进行常规康复治疗和患侧下肢放散式体外冲击波治疗（每周2次）,连续3周,对照组进行常规治疗和安慰性冲击波治疗。分别于治疗前、第三周全部治疗结束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。同时比较两组患者治疗前后腘绳肌、股四头肌、小腿三头肌改良Ashworth分级（MAS）评分,以及患侧下肢的Fugl-Meyer（FMA）评分。 结果：在第三周治疗结束后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相、踝关节最大背屈角度、踝关节最大跖屈角度均较治疗前明显提高（P<0.05）,步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、患侧健侧摆动相比值均较治疗前明显减小（P<0.05）。组间对比显示,治疗后试验组患者步幅、步频、步速、步态周期、步长偏差、踝关节最大背屈角度、踝关节最大跖屈角度均优于对照组（P<0.05）。治疗后试验组腘绳肌、股四头肌、小腿三头肌MAS评分及患侧下肢FMA评分均较治疗前改善(P<0.05),并优于对照组(P<0.01,P<0.05)。 结论：放散式体外冲击波能有效改善脑卒中偏瘫患者步态时空、运动学、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。同时可以降低患侧下肢的痉挛,提高下肢运动功能。     

步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响

目的:采用步态分析,观察步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响.方法:选择40例符合入选标准的脑卒中后足下垂患者,随机分组到实验组和对照组,均给予常规药物治疗及基本常规康复训练.实验组在此治疗基础上采用给予患侧下肢步态诱发功能性电刺激,根据患者踝关节背伸、内翻程度调节正负电极片位置及具体适应的刺激量30min/次,1次/d,每周6次,共3周.对照组在治疗期间不给予任何电刺激.采用三维步态分析仪器分别于治疗前、治疗3周后检测并获取两组患者步态参数.结果:治疗3周后,两组患者步速、步幅、步频、健侧摆动相均较治疗前明显均提高(P＜0.05),步态周期、步宽、双支撑相、患侧摆动相、健侧支撑相、患侧支撑相均较治疗前显著减小(P＜0.05).组间比较显示,治疗组患者的步行速度、步幅、步频、步行周期、步宽、双支撑相、改善程度均明显优于对照组(P＜0.05).两组患者对称性步态参数治疗前后差异显著,且实验组改善程度显著优于对照组(P＜0.05).结论:步态诱发功能性电刺激治疗能有效改善脑卒中后足下垂患者步速、步频、步行周期等时空参数,提高脑卒中后足下垂患者的步行能力及步态的对称性.     

踝足矫形器对脑卒中患者步行能力影响的疗效观察

目的：观察佩戴踝足矫形器（AFO）对脑卒中患者步行能力改善的程度。方法：脑卒中偏瘫患者32例,给予佩戴50S1动态踝足矫形器7d后,采用三维步态分析系统评测佩戴AFO前后的步态空间域参数和步态时间域参数。结果：佩戴7d后,脑卒中患者步态空间域参数中平均步幅宽患、健侧均较佩戴前下降（P〈O．05）,平均步幅长、步伐长和平均步向角患、健侧均较佩戴前增大（P〈0．05,0．01）;步态时间域参数中步速、步频和双支撑相百分比患侧、健侧均较佩戴前明显增加,（P〈O．01）,单支撑相和摆动相百分比患侧较佩戴前明显增加、健侧较佩戴前下降（P〈O．01）。结论：佩戴AFO可以改善脑卒中患者步态的稳定性,患、健侧的步速、步频均明显提高,并且佩戴后即刻发挥作用。     

认知任务干扰脑卒中步态的前驱研究

目的:通过步态分析手段,探讨认知任务对脑卒中患者步态的影响,比较不同认知任务对步态影响的区别。方法:15例脑卒中患者参与本项研究。要求所有患者分别进行两种步行:自然状态下直线步行20m;步行的同时分别执行定向、记忆、计算和言语任务。采用Gaitwatch步态分析系统收集5次步行时的步态参数,包括步频、步幅、步速、双支撑相百分比和健侧摆动相百分比。结果:5组步频无显著性差异(F=1.972,P=0.169),5组步幅(F=13.142,P0.01)、步速(F=11.445,P=0.001)、双支撑相百分比(F=13.142,P0.01)和健侧摆动相百分比(F=11.000,P0.01)有显著性差异。与自然步行相比,4种认知任务时的步幅均显著降低,双支撑相百分比显著提高,定向任务和计算任务时的步速和健侧摆动相百分比显著降低。与计算任务相比,定向任务时的步幅、步速提高,双支撑相百分比降低;记忆任务时步幅、步速和健侧摆动相百分比提高,双支撑相百分比降低;言语任务时步幅和步速提高。结论:认知任务会降低脑卒中患者的步幅、步速和健侧摆动相百分比,延长双支撑相百分比,不同类型认知任务对步态的干扰不同。     

步行支持带联合常规康复治疗脑卒中患者步态的疗效观察

目的 应用三维步态分析评价步行支持带联合常规康复治疗脑卒中患者步态的临床疗效。 方法 将脑卒中患者60例按随机数字表法随机分为步行支持带组20例、AFO组20例和常规治疗组20例。3组患者均接受常规康复治疗,步行支持带组患者采用步行支持带联合常规康复治疗,AFO组患者采用踝足矫形器联合常规康复治疗。于治疗前和治疗4周后（治疗后）采用三维步态分析评价3组患者的三维步态参数。 结果 共统计了57例患者,分别为步行支持带组（20例）、AFO组（19例）和常规治疗组（18例）。治疗后,3组患者的步速、步频和步长较组内治疗前均明显增加,而步宽、双支撑相百分比、健侧支撑相百分比、患侧支撑相百分比和健患侧支撑相比值较组内治疗前则明显减少,差异均有统计学意义（P<0.05）。治疗后,AFO组的步速、步频和步长较常规治疗组治疗后明显增加,步宽较常规治疗组明显减少（P<0.05）;治疗后,步行支持带组的步速、步频和步长较常规治疗组治疗后明显增加,步宽、双支撑相百分比和健侧支撑相百分比较常规治疗组治疗后明显减少,差异均有统计学意义（P<0.05）;治疗后,步行支持带组的双支撑相百分比为（32.05±5.26）%,健侧支撑相百分比为（69.15±2.41）%,较AFO组治疗后明显减少,差异均有统计学意义（P<0.05）。 结论 步行支持带联合常规康复治疗可明显改善脑卒中患者的异常步态,且在增加步行中的支撑能力方面优于踝足矫形器联合常规康复治疗。     

全身振动刺激对脑卒中偏瘫患者步行效率的影响

目的：观察全身振动训练对脑卒中偏瘫患者步行效率的影响。方法：脑卒中患者11例,均进行全身振动刺激,频率10Hz,振幅4mm,时间10min。振动刺激前后进行步态分析。结果：振动刺激10min后,11例患者步频、步速及患侧步长、患侧单支撑相时间、健腿摆动相时间、健侧髋关节最大屈曲角度、健患侧髋关节及膝关节最大屈曲角度、患侧踝关节最大背伸角度均较刺激前明显增加（P〈0.05）;步行周期、双支撑相时间显著缩短（P〈0.05）;健侧步长、健侧单支撑相时间、患腿摆动相时间刺激前后比较差异无统计学意义。结论：全身振动刺激可以显著改善脑卒中偏瘫患者步行时空参数,提高患者的步行能力。     

强化蹲-起训练联合核心稳定性训练对脑卒中偏瘫患者坐-站转移能力及步态对称性的影响

目的：探讨强化蹲-起训练及核心稳定性训练对恢复期脑卒中偏瘫患者坐-站转移能力及步态对称性 的影响。方法：恢复期脑卒中偏瘫患者50例随机分为常规组和强化组,各25例。2组均给予常规康复治疗 并强化核心稳定性训练,强化组在此基础上增加强化蹲-起训练。训练前、训练6周后分别采用5次坐立测 试（FTSST）评估坐站转移能力,起立-行走计时测试（TUGT）评估坐-站-步行能力,Gait Watch三维步态分析 系统评估步态对称性参数（包括步长偏差、健患侧支撑比值及患健侧摆动比值）。结果：训练6周后,2组患 者FTSST、TUGT测试结果,步长偏差、健患侧支撑比值及患健侧摆动比值均显著低于同组训练前（均P＜ 0.05）,且强化组低于常规组（均P＜0.05）。结论：强化蹲-起训练联合核心稳定性训练可有效改善恢复期脑 卒中偏瘫患者坐站转移能力及步态对称性。     

脑卒中偏瘫步态的时空参数与骨盆运动学分析

目的:探讨脑卒中偏瘫步态的时空参数与骨盆的运动学变化特征,从而为其康复治疗提供有价值的依据。方法:运用三维运动解析系统,对符合纳入标准的10例缺血性脑卒中偏瘫步态者进行步态分析,与其基本情况相匹配的健康者10例作为对照。评价两组间在时-空参数、步态周期方面的差异及偏瘫步态者骨盆运动在矢状面、横断面与冠状面上的运动变化特征。结果:脑卒中偏瘫步态者步行速度减慢,步频降低,步宽加大,步长缩短,且健侧步长缩短更为明显。患侧双支撑期在步态周期中所占的比例增加,单支撑期所占的比例减少。健侧支撑期、双支撑期在步态周期中所占的比例增加,摆动期所占的比例减少,健侧在步行中起代偿作用。偏瘫步态骨盆运动表现为骨盆横断面上的旋转度增加和矢状面上倾斜度的增加。结论:三维运动解析系统测试可定量评价与分析偏瘫患者步行功能,定量评价偏瘫患者骨盆运动变化,从而有益于治疗计划的制定。     

脑卒中偏瘫步态分析的临床应用

目的研究脑卒中偏瘫患者的步态特点。方法 49例脑卒中偏瘫患者分成两组,其中观察组33例,不佩戴矫形器,裸足进行三维视频步态分析,与健康成年人步态参数进行比较;对照组16例,佩戴固定式踝足矫形器(AFO)进行步态分析,与观察组比较。结果与正常人相比,观察组步长、跨步长、步频明显减小,步宽增大,步速减慢;步态周期延长,其中双腿支撑期时间和所占步态周期比例明显延长,单腿支撑期所占步态周期比例明显缩短(P<0.01);偏瘫患者是否应用AFO,步态运动学参数无显著性差异(P>0.05)。结论脑卒中偏瘫患者步速慢、步态周期延长、双腿支撑期比例延长、单腿支撑期比例缩短是其主要运动学特点。     

多通道FES踏车训练对脑卒中患者下肢感觉-运动能力的临床影响

目的：观察多通道功能性电刺激踏车训练对脑卒中患者下肢本体感觉、平衡及步态的影响。方法：选取44例脑卒中患者随机分为对照组和观察组，每组22例。对照组给予常规康复训练和普通主被动踏车训练，观察组进行常规康复训练和多通道功能性电刺激踏车训练。治疗前、治疗8周后采用平衡仪评估患者的本体感觉；采用Berg平衡量表(BBS)评估患者的平衡功能；采用三维步态评估患者的步行功能。结果：治疗8周后，2组患者ATE、Time以及步宽的数值均较治疗前降低（P<0.05），且观察组的数值更低于对照组（P<0.05)；2组患者BBS评分、步长、步速、健侧时间摆动占比以及下肢各关节最大活动角度的数值均较治疗前提高（P<0.05），且观察组的数值更高于对照组（P<0.05)；患者患侧下肢ATE差值与步宽差值呈正相关（P＜0.05），与步长差值、步速差值、健侧摆动时间占比差值、患侧髋关节/膝关节/踝关节屈伸角度差值均呈负相关（P＜0.05）；患者Time差值与步宽差值呈正相关（P＜0.05），与步长差值、步速差值、健侧摆动时间占比差值、患侧髋关节/踝关节屈伸角度差值均呈低度负相关（P＜0.05）。结论：在常规康复治疗基础上联合使用多通道功能性电刺激踏车训练可以有效提高脑卒中患者的本体感觉，进一步改善平衡功能以及步态。     

运用三维步态分析评价下肢机器人训练对偏瘫患者步行能力的影响

目的应用三维步态分析评价下肢机器人训练对脑卒中偏瘫患者步行功能的影响。 方法采用随机数字表法将60例脑卒中偏瘫患者分为观察组及对照组,两组30例。2组患者均给予常规药物治疗及康复干预,对照组同时辅以传统下肢步行训练,观察组则辅以下肢机器人训练。2组患者下肢训练时长均为每次30min,每周训练5d。于治疗前、治疗8周后分别采用三维步态分析系统检测2组患者步态时间参数、时相参数、关节活动角度及地面反作用力大小等指标。 结果观察组患者经下肢机器人辅助训练后,其步速［(59.34±12.20)cm/s］、步频［(89.39±13.80)次/分钟］、跨步长［(74.17±15.54)cm］提高,步宽［(18.69±3.16)cm］缩小;患侧支撑期百分比［（69.72±10.06）%］、健侧与患侧支撑期比值（1.07±0.11）、双支撑期百分比［（16.85±8.23）%］、髋关节最大活动度［（35.39±9.31）°］、膝关节最大活动度［（50.21±15.34）°］、垂直地面反作用力峰值占体重百分比［（109.36±13.28）%］、患侧向前地面反作用力峰值占体重百分比［（6.95±1.98）%］均明显改善,与治疗前及对照组间差异均具有统计学意义（均P<0.05）。 结论与传统步行训练比较,下肢机器人训练能更有效改善脑卒中偏瘫患者步行功能,该疗法值得临床推广、应用。     

Augmented reality-based postural control training improves gait function in patients with stroke: Randomized controlled trial

The purpose of this study was to determine the effects of augmented reality (AR)-based postural control training on balance and gait function in stroke patients. Twenty-one stroke patients were assigned to either an experimental group (n = 10) or a control group (n = 11). Patients in both groups received a general physical therapy program for a duration of 30 minutes per session, 5 days per week, for a period of 4 weeks. Participants in the experimental group received additional AR-based postural control training for 30 minutes per day, 3 days per week, for a period of 4 weeks. Patients were assessed with the timed up-and-go test, Berg Balance Scale test, and spatiotemporal parameters using the GAITRite system. Results of repeated-measures analysis of covariance showed a significant main effect of time on timed up-and-go test, Berg Balance Scale, velocity, cadence, step length and stride length of paretic and nonparetic sides. In addition, walking velocity, step length, and stride length on both the paretic and nonparetic sides showed a significant group × time interaction effect. The results of this study provide evidence in support of incorporating an AR environment into postural control training for improving gait of stroke patients.     

The effects of symmetric center of pressure displacement training with feedback on the gait of stroke patients

[Purpose] This study investigated the effects of COP displacement training using visual feedback had on the gait of patients with hemiplegia due to stroke. [Subjects and Methods] This study was conducted with 20 patients with hemiplegia due to stroke. The training consisted of five training sets repeated 10 times and the activity was conducted for 15 minutes each session, three times per week for six weeks immediately after completion of central nervous system developmental treatment. [Results] A comparison of the results of before and after the experiment found that the COP displacement training group showed significant improvements in step length, stride length, gait velocity, and the functional reach test, while the control group showed significant improvement only in the functional reach test. In the intergroup comparison, the COP displacement training group showed significant improvements in paretic side step length, paretic side stride length, gait velocity, and the functional reach test compared to the control group. [Conclusion] In conclusion, according to the results of this study, visual feedback training for COP displacement is more effective at enhancing the gait and balance of hemiplegic patients due to stroke than only performing feedback training for even weight distribution.Key words: Stroke, Center of pressure, Feedback     

The effects of a progressive resistance training program on walking ability in patients after stroke: a pilot study

[Purpose] The purpose of this study was to evaluate the effects of a progressive resistance training (PRT) program on the walking ability of chronic stroke patients with hemiparesis following chronic stroke. [Subjects and Methods] The participants of this study were fifteen hemiplegic patients. The main outcomes measured for this study were the peak torque of the knee extensor; the gait ability as measured by electric gait analysis of walking speed, walking cycle, affected side stance phase, affected side stride length, symmetry index of stance phase, and symmetry index of stride length; and 10-m walking speed; and the Berg balance scale test. [Results] Walking speed and affected side stride length significantly increased after the PRT program, and 10-m walking time significantly decreased after RPT in stroke patients. [Conclusion] These results suggest that the progressive resistance training program may, in part, improve the stride of the affected side leg of stroke patients after stroke and also positively impact walking speed.Key words: Progressive resistance training program, Walking ability, Stroke     

Effects of auditory feedback during gait training on hemiplegic patients’ weight bearing and dynamic balance ability

[Purpose] This study examined the effects of auditory feedback during gait on the weight bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic patients participated in this experiment and they were randomly allocated to an experimental group and a control group. [Methods] Both groups received neuro-developmental treatment for four weeks and the experimental group additionally received auditory feedback during gait training. In order to examine auditory feedback effects on weight bearing during gait, a motion analysis system GAITRite was used to measure the duration of the stance phase and single limb stance phase of the subjects. [Results] The experimental group showed statistically significant improvements in the duration of the stance phase and single limb stance phase of the paretic side and the results of the Timed Up and Go Test after the training. [Conclusion] Auditory feedback during gait training significantly improved the duration of the stance phase and single limb stance phase of hemiplegic stroke patients.Key words: Auditory feedback, Gait, Hemiplegic patients     

Effects of increasing non-paretic step length on paretic leg movement during hemiparetic gait: a pilot study

[Purpose] Gait training that increases non-paretic step length in stroke patients increases the propulsive force of the paretic leg. However, it limits knee flexion during the swing phase of gait, and this may cause gait disturbances such as worsening of gait pattern and increased risk of falling. Therefore, this study aimed to investigate the effects of increasing non-paretic step length on the joint movement and muscle activity of a paretic lower limb during hemiparetic gait. [Participants and Methods] A total of 15 hemiparetic patients with chronic stroke were enrolled in this study. Spatiotemporal parameters, along with kinematic and electromyography data of their paretic lower limbs, were measured during a 10-m distance overground walking. Two walking conditions were assessed: normal (comfortable gait) and non-paretic-long (gait with increased non-paretic step length) conditions. [Results] Under the non-paretic-long condition, the trailing limb angle was larger than under the normal condition. However, no significant difference was observed in the knee flexion angle during the swing phase. [Conclusion] Increasing non-paretic step length during gait is unlikely to limit knee flexion during the swing phase and can safely improve the propulsive force of a paretic leg.     

Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis

Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M. Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis.

Objective

To examine the short-term effects of a newly developed hemiparetic gait training in which patients walk with a prosthesis applied to the nonparetic leg in the flexed knee position.

Design

Pre-post nonrandomized controlled trial.

Setting

Rehabilitation center and gait laboratory of a university hospital.

Participants

Community-dwelling ambulatory volunteers (N=22) with chronic hemiparesis caused by a unilateral stroke.

Intervention

Study subjects participated in a gait training program using either a below-knee prosthesis or a treadmill. Treadmill gait training was performed at a speed approximating the maximum gait velocity for each patient. The 3-week program consisted of a 5-minute gait training session 2 to 3 times a day.

Main Outcome Measures

The ground reaction forces, stance time, step length and cadence during walking at a comfortable speed, and maximum gait speed, as well as the Berg Balance Score, were estimated before and after each training program.

Results

In comparison with changes after the treadmill gait training, analyses of covariance demonstrated a significant increase of the fore-aft ground reaction forces during the paretic propulsion phase and a significant increase in the relative durations of the paretic and nonparetic single stance involved in a gait cycle after the prosthetic gait training (P<.05).

Conclusions

Prosthetic gait training would have different effects on a hemiparetic gait than treadmill gait training. The gait-related task inducing the dominant use of the paretic leg to support the body may be useful as a rehabilitative treatment to improve the kinetic abilities in the paretic stance period.     

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

Background

A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.

Methods

Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.

Findings

The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.

Interpretation

Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.