Simulation of paretic gait in normal subjects by loading the ankles

Normal subjects were loaded with increasing weights (2-6 kg) applied around the ankles. During these conditions stride length increased in relation to velocity. The percentage duration of single support in relation to stride duration increased. Provided the same load was applied around both ankles increase was symmetrical. Consequently there was also an increase of swing as well as a decrease of stance and of double support. The results contrast in all respects to what was found in previous experiments when the load was carried in the hand. During these conditions stride length decreased as well as the duration of single support. The two experimental conditions differed in that with ankle loading the swing phase was loaded while in the other case stance was loaded. The two types of experiment may help to explain why some patients with paretic legs walk with short strides, while others walk with strides that are normal or slightly prolonged.     

Dynamic analysis of above-knee amputee gait

BACKGROUND: It is important to understand the characteristics of amputee gait to develop more functional prostheses. The aim of this study is to quantitatively evaluate amputee gait by dynamic analysis of the musculoskeletal system during level walking and stair climbing. METHODS: Dynamic analysis using gait analysis, electromyography and musculoskeletal modeling for above-knee amputees (n=8) and healthy adults (n=10) was performed to evaluate the muscle balance, muscle force, and moment of each major muscle in each ambulatory task. Time-distance parameters and the kinematic parameter of gait analysis were calculated, and a root mean square electromyogram of major muscles and hamstring and tibialis anterior coactivity was measured using electromyography. Lastly, dynamic analyses of above-knee amputee gaits were performed using musculoskeletal models with scaled bones and redefined muscles for each subject. FINDINGS: Most kinematic parameters showed statistically no difference among the tasks, excluding pelvic tilt, pelvic obliquity, and hip abduction. Major muscle activities and coactivities of the hamstring and tibialis anterior showed that the stair ascent task needed more muscle activity than the stair descent task and level walking. The muscle activity and coactivity of amputees were greater than those of healthy subjects, excluding the hamstring coactivity during stair ascent (P<0.05). Lastly, dynamic analysis showed that weakened abductor and excessive adductor and then inadequate torque during all tasks were quantitatively observed. INTERPRETATION: Dynamic analysis of amputee gait enabled us to quantify the contribution of major muscles at the hip and knee joint mainly in daily ambulatory tasks of above-knee amputees and may be helpful in designing functional prostheses.     

A comparison of the gaits of paretic patients with the gaits of control subjects carrying a load

The gaits of 15 patients with peripheral and central paresis were studied. They were compared both with a control group of the same age and sex and with a group of nine subjects who carried varying weights. Velocity was low in the patients and this was due to decreases of both stride length and stride frequency. Load did not significantly decrease the velocity of the control subjects, since unlike the patients, they had the ability to compensate for a low stride length by significantly increasing stride frequency. The significant lowering of stride length in both groups was a similarity between them. The patients were also similar to the loaded normal subjects in having a shortened duration of the single support and a prolonged double support. The patients with hemisymptoms also showed significant differences between the two sides for the durations of both single and double support. The results obtained from this study justify our hypothesis that a subject who is carrying a load may in certain respects be considered as a model of a subject with paresis. The remaining differences may be explained by the fact that in the experimental situation, the leg was loaded only during stance, while in paresis the legs may be considered relatively loaded during the whole stride.     

A型肉毒毒素治疗对脑卒中患者踝阵挛及步行功能的影响

目的:观察超声引导下A型肉毒毒素治疗对脑卒中患者踝阵挛及下肢功能运动功能的疗效。方法:43例脑卒中患者随机分为治疗组(n=22)和对照组(n=21)。两组常规治疗相同,治疗组在超声引导下将A型肉毒毒素400U注射入腓肠肌、比目鱼肌及胫后肌;对照组给予巴氯芬30mg/d治疗。两组患者分别于治疗前和治疗2周后采用踝阵挛分级法、Biodex步行测试仪分别对患者进行评估。结果:两组患者一般资料差异无显著性意义。治疗前两组患者的踝阵挛分级、步速、健侧步长、患侧步长、健侧/患侧步长比、健侧步行所占时间比和患侧步行所占比差异无显著性意义。与对照组相比,治疗2周后,治疗组患者的踝阵挛分级、步速、健侧步长、患侧步长、健侧/患侧步长比、健侧步行所占时间比和患侧步行所占比分别为均有改善,差异均有显著性意义(P0.05)。结论:与口服巴氯芬相比,短期内,A型肉毒毒素能更好地减轻踝阵挛,提高步速,改善患者步行质量。     

The initiation of gait in lower limb amputees: some related data

The initiation of gait, from balanced standing position to the toe-off of the stance leg, was analyzed in 8 unilateral above-knee (AK) and 10 unilateral below-knee (BK) males amputees. Thirty-one parameters were measured, including ground-foot forces and the movements and timing of hip, knee, and ankle joints. The significant changes from the normal pattern of initiation of gait found in the AK and BK amputees, as well as significant changes between the two amputees groups themselves, are described. The amputees were divided into two subgroups: those who start walking with their prosthesis and those starting with their normal leg. The two groups were compared statistically for each amputation level and all were compared to a normal subjects group. Differences relating to the choice of the swing leg were found. The findings are reported as part of a future databank.     

Effect on gait using various prosthetic ankle-foot devices

Five different commonly prescribed ankle-foot devices for below-knee prostheses were tested for effects on gait: SACH, SAFE, SEATTLE, SINGLE AXIS, and MULTIPLE AXIS. Subjective ratings by the amputees served to resolve which physical variables determined the preferred ankle-foot device. Ratings were related to age, body weight, length of residual limb, and ratio of stride frequency to stride length. Distinctions in performances were derived from analyses of anterior-posterior angular accelerations occurring in the prosthesis immediately following heel strike. The accelerations were characterized as a damped oscillatory waveform. These objective findings, when related to the subjective ratings, showed that the amputees preferred devices which developed the lesser shock and greater damping.     

膝上截肢患者穿戴假肢后的功能评定

20例膝上不同水平截肢患者穿戴假肢后,利用步态分析、步行能力及假肢的悬吊能力三项指标进行功能评定。结果综合评定优秀率以膝离断假肢为最佳达89％,依次为大腿中下1/3截肢、大腿中段截肢、大腿中上1/3截肢,髋离断假肢功能评定优秀率最低。提示骨科医师应重视截肢平面的选择。同时步态分析、步行能力及假肢悬吊能力三项评定指标为完善下肢假肢功能的评定提供了有益的参考指标。本组20例膝上不同水平截肢患者的假肢代偿功能总优良率达76.6％。     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周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。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。     

Gait Changes Caused by the Habits and Methods of Carrying a Handbag

[Purpose] The purpose of this study was to provide information to help maintain correct posture by identifying gait changes caused by the habits and methods of carrying bags. [Method] The subjects were 34 healthy right-handed women. Among them, 18 subjects had the habit of carrying bags on their right side, and 16 subjects had the habit of carrying bags on their left side. The subjects were instructed to walk while carrying a bag, which weighted approximately 10% of the subjects'' average weight, in four different ways; holding it in the left hand, carrying it over the left shoulder, holding it in the right hand, and carrying it over the right shoulder. The subjects'' gaits were measured using a gait analyzer. [Results] Subjects who habitually carried bags on their right exhibited changes in gait variables related to walking distance. In addition, their gait velocities were relatively faster. On the other hand, differences in temporal and spatial gait variables were not exhibited when the bag was carried using the four methods. [Conclusion] When the weight of a bag is appropriate, bag-carrying habits had significant effects on gaits. Therefore, people who carry bags should avoid the habit of carrying them on only one side.Key words: Gait, Methods of carrying bag, Habits of carrying bag     

帕金森病患者步态测量与定量分析

摘要 目的：提取帕金森病患者步态运动学和时空参数,通过实验分析找到可以作为步态量化评估的特征参数,为医生提供康复评估的依据。 方法：本文采用基于刚体的虚拟标识点方法在受试者下肢解剖学关键点设置标识点获取其步态信息。受试者被分为开机组(DBS ON),关机组(DBS OFF)和对照组(Control),运动捕捉仪记录受试者多个步态周期的虚拟标识点三维坐标。提取包括关节角度、支撑相比率、双支撑相比率、步态周期时间、步频、步长和步速等在内的步态运动学及时空参数。对三组步态特征参数进行单因素一元方差分析。 结果：各组间下肢各关节角度变化范围、支撑相比率、双支撑相比率、步长和步速差异均有显著性(P<0.01),且随受试者症状的减轻,关节角度变化范围、步长和步速有显著递增趋势 (DBS OFFDBS ON>Control)。 结论：基于刚体的虚拟标识点可以准确测量人体步态。提取出的关节角度变化范围、支撑相比率、双支撑相比率,步长和步速均可作为帕金森病患者康复评估的依据。     

Gait analysis in amputees

There are marked differences from normal in both AK and BK gait. Forward velocity of walking is significantly lower in the amputee and is lower in the AK than in the BK subjects. Traumatic AK amputees ambulate with time-distance parameters of velocity, cadence, stride length and gait cycle which are all two standard deviations below normal. The same parameters for the traumatic BK amputee are only one standard deviation below normal. The symmetry of walking seen in the normal subject is not present in the lower extremity amputee. Measurements of single limb support times and motion analysis of the lower extremities as well as of the head, arms and trunk bear this out. This asymmetry of motion increases the excursion of the center of mass during each cycle and thereby increases the energy cost of ambulation. Energy cost of amputee gait often places the dysvascular AK amputee at his limits and strains other amputees severely. Further research is necessary to enable amputees to approach the walking capabilities of normal people.     

Factors influencing rehabilitation of arteriosclerotic lower limb amputees

This survey considered 598 arteriosclerotic amputees over a period of 9 years: 267 below-knee; 81 Gritti-Stokes; 195 above-knee; and 55 double amputees. A walking ability index (WAI) ranging from 1 for a normal gait to 6 for inability to walk was determined for these amputees by clinical grading at 3, 6, 9, and 12 months after prosthesis fitting. Amputees with the below-knee operation had better WAI at 3 and more months than those with either Gritti-Stokes or above-knee operations. There was no statistical evidence for a difference between Gritti-Stokes and above-knee operations at any time of assessment of WAI. The 50-59 year-old age group had significantly better WAI at 6, 9, and 12 months than did the 60-69 or 70+ age group, but the 60-69 year-old group was not significantly different from the 70+ age group. On an average, the 78 amputees (14 percent) with ischemic heart disease had a poorer WAI at 6 and more months than did those without it; the 46 amputees (8 percent) with hemiplegia were worse at 12 months than those without hemiplegia; and the 15 amputees (11 percent) with bronchitis were worse at 12 months than those without bronchitis. Double amputees had poorer WAIs at 12 months than those of single amputees.     

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。     

Gait in hemiplegia: evaluation of clinical features with the Wisconsin Gait Scale.

OBJECTIVE: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of changes in hemiplegic gait in post-stroke patients. DESIGN: A prospective observational study. SUBJECTS: Ten healthy subjects and 56 hemiplegic outpatients, more than 12 months post-stroke, consecutively admitted in a rehabilitation centre. METHODS: Patients were videotaped while walking at a comfortable speed. Quantitative and clinical gait parameters were derived from videotaped walking tasks at admission and at the end of a period of rehabilitation training. Qualitative features were assessed using the Wisconsin Gait Scale. Functional status was rated through the modified Barthel Index. RESULTS: After training, the median Wisconsin Gait Scale score improved significantly (28 vs 26.5; p = 0.003). In particular, "weight shift to paretic side" and patterns during the swing phase of the affected leg were improved. Gait velocity (0.3 vs 0.4 m/sec; p = 0.001) and stride length (77 vs 85 cm; p = 0.0002) increased significantly, whereas number of steps (25 vs 23; p = 0.004), stride period (2.5 vs 2.3 sec; p = 0.04), and stance period (2.1 vs 2 sec; p = 0.03) of the unaffected side were reduced. The Barthel Index score increased (71 vs 78; p = 0.005). CONCLUSION: The Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results.     

Causes and correction of abnormal gait patterns due to prosthesis in above-knee amputees

Abnormal gait patterns cause an increase in the energy cost of walking in above-knee amputees. Disturbances of the walking pattern are often caused both by the amputated patient himself and by incorrect prosthetic fitting. The early detection and correction of causative factors is of great importance for successful rehabilitation of these amputees. During the follow-up examinations the prosthesis must be inspected for a correct fitting and individually appropriate knee stabilizing components. Prior to any corrective measures it must be excluded that the artificial limb has been put on incorrectly by the amputee himself.     

Gait assessment for neurologically impaired patients. Standards for outcome assessment

This study compared the temporal-distance (TD) gait values of two groups of neurologically impaired subjects with published TD gait values of healthy subjects and analyzed the influence of nine clinical characteristics on TD values in the neurologically impaired subjects. Velocity, cadence, step length, stride length, and ratio of stride length to lower extremity length were recorded for 37 subjects with hemiparesis and 24 subjects with multiple sclerosis. Temporal-distance values were well below normal values, even in functionally independent subjects. Overall, the subjects with hemiparesis had lower values than the subjects with multiple sclerosis. Of the nine characteristics examined, only diagnosis, etiologic factor (for hemiparesis), type of ambulation aid, and functional category were related significantly to TD values. Our findings suggest that TD gait performance goals for patients with neurological impairment should be based on values from impaired rather than healthy subjects and that these goals should be adjusted for the individual patient's diagnosis, etiologic factor, type of ambulation aid, and functional category.     

The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study

The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke. Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups. In addition to conventional physical therapy, the experimental group participated in 15 treadmill-training sessions in which a handrail was used for external support. The control group received the same number of equal length sessions of over-ground ambulation. Treatment effects were established by pre- and posttreatment assessment of: 1) functional walking ability, 2) walking speed, 3) stride length, 4) temporal characteristics of gait, and 5) electromyographic activity of calf muscles. Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors. The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus. Furthermore, the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation, stride length, percentage of paretic single stance period, and gastrocnemius muscular activity.     

Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors

ObjectiveTo describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function.DesignCohort study.SettingMotion analysis laboratory in a tertiary-care free-standing rehabilitation hospital.ParticipantsConsecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100).InterventionsNot applicable.Main Outcome MeasuresGait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients.ResultsExcept the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004).ConclusionsGait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.     

Détermination de la puissance interne au cours de la marche de personnes amputées fémorales. Influence de la vitesse

The energy consumption of transfemoral amputee is increased compared with asymptomatic people. Internal power during gait at different walking speeds can help to understand this phenomenon. Eight transfemoral amputees and six asymptomatic subjects participated in this study. Internal power of each lower limb was computed and it demonstrated an asymmetry between the two lower limbs of the patients. The method proposed to calculate internal work has the main advantage that it allows to differentiate the work performed by each limb. This is particularly interesting for patients with very asymmetric gaits like amputees.