老年人助步需求调查与分析

目的：文章基于老年人相关生理和心理特征,以市场上现有的助行产品为主要研究对象,将目标人群限定为患有轻、中度运动障碍的老年人,探究我国老年人助行器需求特点以改进现有助行产品。方法：通过观察无锡某护理院和某小区共76名老年人使用助行器的行走步态和进行“起立-行走”计时测试与“座椅站立”实验,辅之以访问调查和访谈法,收集数据后运用统计学方法处理分析数据、建立表格并进行对比。结果：老年人使用助行器后,行走步态与平衡功能有明显改善,“起立-行走”与“座椅站立”用时减少。结论：助行器的使用可改善老年人平衡功能和行走步态;老年人生理和心理情况对使用助行器都产生了一定的影响;现下使用的助行器种类单一、质量低下、价格昂贵,亟待改善。     

梓醇对永久性脑缺血大鼠恢复早期实时步态的影响

目的：观察梓醇对pMCAO 大鼠恢复期早期实时步态的影响,评价其对缺血性卒中的改善作用。方法：将大鼠随机分为6 组,即正常对照组,模型组,阳性药天保宁组,梓醇15、30、60 mg·kg-1 组。于术前进行为期7 天的步态仪行走训练,每3 次。训练完成后,采用线栓法建立永久性大脑中动脉栓塞（pM原CAO）大鼠模型,并于术后3~14 天连续给药,术后第14 天进行实时步态行为检测。结果：术后14 天,与正常组比较,pMCAO 模型大鼠平均步行周期显著延长（P<0.01）,绝对值平均体转角明显升高（P<0.05）,双足支撑时长缩短（P<0.05）,三足支撑时长延长（P<0.01）,协调性指标显著增加（P<0.01）。与模型组比较,梓醇30 mg·kg-1 及60 mg·kg-1 组模型动物步行周期、降低绝对值平均体转角显著缩短（P<0.05 或P<0.01）;梓醇30 mg·kg-1 组右前相对于其他三足的协调性指数明显降低（P<0.05）,脑缺血动物协调性提高。结论：梓醇可部分改善脑缺血模型大鼠的实时步态行为变化,对缺血性卒中的神经功能有一定保护作用。     

中药熏蒸联合个体化康复治疗方案对脑瘫患儿步态的影响

目的:分析中药熏蒸联合个体化康复治疗方案对脑瘫患儿步态的影响.方法:选择我院收治的痉挛性脑瘫伴有尖足步态的124例脑瘫患儿,随机分为治疗组和对照组各62例.对照组采用个体化康复治疗方案,治疗组在个体化康复治疗的基础上应用中药熏蒸治疗.结果:治疗组患者治疗后的支撑相最大前向地面反作用力(GRF)、支撑相初期踝关节最大背屈角度、支撑相末期踝关节接最大跖屈角度、踝头节被动活动范围(PROM)、粗大运动功能量表(GMFM)站立、GMFM走跑跳分别为(1.32 ±0.18),(30.17 ±14.18),(-21.28 ±15.14),(18.82±8.84),(44.28 ±9.91),(34.62 ±1.85),高于对照组患者的(1.19 ±0.17),(27.89±15.12),(-24.81 ±13.87),(14.49±8.76),(34.62±1.85),(29.15±4.88);治疗组患者治疗后的支撑相最大后向GRF,综合痉挛量表(css)评分分别为(-0.27±0.12),(8.04±1.88),低于对照组患者的(-0.23±0.13),(9.37 ±2.04).结论:中药熏蒸联合个体化康复治疗方案可以提高脑瘫患儿的康复治疗效果.     

Phenotypic and immunohistochemical characterization of sarcoglycanopathies

INTRODUCTION:

Limb-girdle muscular dystrophy presents with heterogeneous clinical and molecular features. The primary characteristic of this disorder is proximal muscular weakness with variable age of onset, speed of progression, and intensity of symptoms. Sarcoglycanopathies, which are a subgroup of the limb-girdle muscular dystrophies, are caused by mutations in sarcoglycan genes. Mutations in these genes cause secondary deficiencies in other proteins, due to the instability of the dystrophin-glycoprotein complex. Therefore, determining the etiology of a given sarcoglycanopathy requires costly and occasionally inaccessible molecular methods.

OBJECTIVE:

The aim of this study was to identify phenotypic differences among limb-girdle muscular dystrophy patients who were grouped according to the immunohistochemical phenotypes for the four sarcoglycans.

METHODS:

To identify phenotypic differences among patients with different types of sarcoglycanopathies, a questionnaire was used and the muscle strength and range of motion of nine joints in 45 patients recruited from the Department of Neurology – HC-FMUSP (Clinics Hospital of the Faculty of Medicine of the University of São Paulo) were evaluated. The findings obtained from these analyses were compared with the results of the immunohistochemical findings.

RESULTS:

The patients were divided into the following groups based on the immunohistochemical findings: α-sarcoglycanopathies (16 patients), β-sarcoglycanopathies (1 patient), γ-sarcoglycanopathies (5 patients), and non-sarcoglycanopathies (23 patients). The muscle strength analysis revealed significant differences for both upper and lower limb muscles, particularly the shoulder and hip muscles, as expected. No pattern of joint contractures was found among the four groups analyzed, even within the same family. However, a high frequency of tiptoe gait was observed in patients with α-sarcoglycanopathies, while calf pseudo-hypertrophy was most common in patients with non-sarcoglycanopathies. The α-sarcoglycanopathy patients presented with more severe muscle weakness than did γ-sarcoglycanopathy patients.

CONCLUSION:

The clinical differences observed in this study, which were associated with the immunohistochemical findings, may help to prioritize the mutational investigation of sarcoglycan genes.     

Novel MRI‐compatible tactile stimulator for cortical mapping of foot sole pressure stimuli with fMRI

Foot sole somatosensory feedback is critical to motor control and declines with aging and disease. To enable study of cortical networks underlying foot sole somatosensation, we developed a pneumatic tactile stimulator capable of producing one degree‐of‐freedom (DOF) oscillations with preset waveform, frequency (≤10 Hz), force magnitude (5–500 N), duty cycle (20–100%), and contacted surface area over which pressures are applied to the foot sole. Image tests (anatomical/functional/field map) of a phantom demonstrated that the device is compatible with 3 T MRI. Gradient‐recalled echo‐planar images of seven healthy young adults using a typical block‐designed 1 Hz sinusoidal stimulation protocol revealed significant activation contralaterally within the primary somatosensory cortex and paracentral gyrus, and bilaterally within the secondary somatosensory cortex. The stimulation system may therefore serve as a research tool to study functional brain networks involved in the perception and modulation of foot sole somatosensation and its relationship to motor control. Magn Reson Med 69:1194–1199, 2013. © 2012 Wiley Periodicals, Inc.     

Dual tasking affects lateral trunk control in healthy younger and older adults

Assessing the effects of attention-demanding tasks on trunk movement provides useful insights into postural control while walking in an attention-split situation, such as occurs in daily life. The coefficient of attenuation of acceleration (CoA) at the trunk is a useful gait index to assess whole trunk movements. We investigated the effect of attention-demanding tasks on CoA to assess the role of attention on trunk control during walking. Thirty healthy, community-dwelling older adults (70.1 ± 5.6 years) and 38 younger adults (22.1 ± 3.4 years) participated in this study. Participants walked 20 m at a self-selected speed (slow, normal, fast) and while performing an attention-demanding cognitive task. Trunk acceleration was measured using triaxial accelerometers attached to the lower (L3 spinous process) and upper (C7 spinous process) trunk and used to compute CoA (the reduction in acceleration from the lower to upper trunk). Results showed that an attention-demanding task significantly decreased CoA in the medio-lateral (ML) direction in both age groups (p < 0.001), whereas it did not affect CoA in the vertical (VT) and anterior–posterior (AP) directions. Our findings suggest that the priority of whole trunk control in the ML direction may be higher than in other directions and be strongly associated with attention, whereas whole trunk control in the VT and AP directions may be passively regulated and require minimal attentional control.     

A method to differentiate the causes of stiff-knee gait in stroke patients

Stiff-knee gait (SKG) is a common abnormal gait pattern in patients after stroke characterized by insufficient knee flexion (KF) during swing. Overactivity of the rectus femoris (RF) is considered the primary cause of SKG. Inadequate push-off has been indicated as an additional cause in the recent literature, as KF depends on knee flexion velocity in preswing (KFV).We used the peak of vertical acceleration of the malleolus (PMVA) as a kinematic-based indirect measure of push-off and studied its relationship with KF and KFV in a sample of 20 healthy subjects walking fast (v = 95 ± 5%height s^?1), at self-selected speed (v = 74 ± 5%height s^?1), slow (v = 54 ± 6%height s^?1) and very slow (v = 38 ± 5%height s^?1) and in a sample of 52 stroke patients with SKG (age 60 ± 11, v = 20 ± 11%height s^?1).In healthy subjects PMVA occurred before knee flexion acceleration (p < 0.001) and hip flexion acceleration (p < 0.001). KF appeared as a bottom-up mechanism driven by the ankle push-off. From a regression analysis, the PMVA-KFV cause–effect relationship resulted strictly linear, with R² = 0.967, KFV = 0 + 7.1 × PMVA, P < 0.0001.Data from SKG patients were compared to this normal cause–effect model. For 44/52 patients the reduced KFV was combined with lack of push-off. Data from 8/52 patients only were statistically outside the 95%CI of the model, thus requiring for a braking mechanism to explain KFV reduction.In stroke adults of our sample the push-off impairment (85% of cases) and not the inappropriate knee extension moment produced by the thigh muscles was the primary cause of SKG. This result could explain the low average efficacy (<10°) of focal and surgical treatments at the quadriceps.The presented model could be used to differentiate the primary cause of SKG between inadequate push-off and braking activity of the thigh muscles, thus increasing the effectiveness of the selected treatment.     

骨水泥型与非骨水泥型全膝关节置换后的步态差异

背景：全膝关节置换已经被证明是一种有效治疗膝骨性关节炎的方法,但是不同类型的全膝关节置换假体固定方式术后所产生的膝关节下肢生物力学差异至今仍不明确。 目的：通过三维步态分析骨水泥固定和非骨水泥固定两种不同的全膝关节置换术后患者的膝关节生物力学差异。 方法：分别选取骨水泥型全膝关节置换以及非骨水泥型全膝关节置换患者各16例,通过测力台以及三维步态分析系统比较2组患者术前以及术后3个月的膝关节生物力学变化并进行对比。 结果与结论：与手术前相比两组患者术后步速及步长均明显增加,支撑相在整个步态周期中的百分比明显减小, 膝关节屈在支撑相及摆动相中最大屈曲角度均明显增加,膝关节外翻角度增加。两种患者术后膝关节内翻角度以及膝关节内收力矩均明显减小。提示,骨水泥型与非骨水泥型全膝关节置换术均能有效改善膝骨性关节炎患者的步行能力以及下肢关节功能,两者间未见明显生物力学差异。     

Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost

Background:

The evidence for the effectiveness of orthopaedic surgery to correct crouch gait in cerebral diplegic is insufficient. The crouch gait is defined as walking with knee flexion and ankle dorsiflexion through out the stance phase. Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. We retrospectively evaluated the effect of surgery on the mobility and energy consumption at one year or more with the help of validated scales and scores.

Materials and Methods:

18 consecutive patients with mean age of 14.6 years with cerebral diplegia with crouched gait were operated for multilevel orthopaedic surgery. Decisions for surgery were made with the observations on gait analysis and physical examination. The surgical intervention consisted of lengthening of short muscle-tendon units, shortening of long muscles and correction of osseous deformities. The paired samples t test was used to compare values of physical examination findings, walking speed and physiological cost index. Two paired sample Wilcoxon signed rank test was used to compare functional walking scales.

Results:

After surgery, improvements in functional mobility, walking speed and physiological cost index were found. No patient was able to walk 500 meters before surgery while all were able to walk after surgery. The improvements that were noted at one year were maintained at two years.

Conclusions:

Multilevel orthopedic surgery for older children and adolescents with crouch gait is effective for improving function and independence.