Stepping to the Beat Improves Spatiotemporal Characteristics of Gait in Stroke Patients with Hemiparesis: A Proof of Concept Case Study of a Home-based Training Intervention
Stepping to the Beat Improves Spatiotemporal Characteristics of Gait in Stroke Patients with Hemiparesis: A Proof of Concept Case Study of a Home-based Training Intervention
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跟随节拍改善中风偏瘫患者的步态时空特征：家庭训练干预的概念验证案例研究
DOI：
10.1016/j.sbspro.2014.02.374
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发表时间：
2014
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Brownless B
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作者：
Brownless B
脑卒中偏瘫步态的特点是时间不对称性和变异性。研究表明，这可以通过听觉提示来改善，即参与者通过视觉或听觉提示训练时间和空间。这种特殊的方法是有效的训练对称步态，并有助于提高协调性和速度。我们描述了一个试点研究，调查的可能性，培训与听觉节奏节拍器嵌入音乐，在加强到位，在家庭为基础的设置。原地踏步结合了对成功步态也很重要的运动方面，例如及时协调和同步的腿部相互屈曲和伸展，产生步频，摆动相位和单肢支撑。原地踏步也可以为基于家庭的培训提供有价值的方法，因为在家里需要的空间很小，因此参与者不太可能摔倒。本个案研究旨在证明在家中环境中的踏步可能是中风后运动训练的有用工具。一位中风偏瘫患者PF成功地完成了为期6周的以家庭为基础的训练，每天15分钟，每周5天（每周增加5%的音乐克里思）。PF（58岁）是一名男性，右利手，慢性中风幸存者，左侧轻偏瘫。他是从当地一家中风俱乐部招募的，入选标准是他能够在没有监督的情况下独立行走（但能够使用步态辅助工具，如手杖或步行者），并且没有听力障碍。最后，PF还能够完成3 m计时起立和行走，这通常用作福尔斯的指标，并提供了患者在转身过程中的能力指标。在为期12周的研究期间，他接受了五次评估，包括基线，三周训练，三周休息（用于测量休息效果），第二个三周训练期，最后再休息三周。在每次评估期间，PF在10米步行任务期间测试其步态速度。在这些测试中，我们还捕获了时空参数，他的步态使用六个加速度传感器（OPAL，APDM）。传感器被放置在躯干、腰椎、左右小腿和脚周围，旨在测量行走。与使用标准临床测量相比，使用这种运动捕捉系统旨在提供对步态康复后可能发生的运动变化的更灵敏和客观的测量。我们还使用了以下临床评估：动态步态指数（测量行走过程中的平衡）和Rivermead运动量表（测量一般行走能力）。结果显示PF步态的所有时空方面都有显着改善。在他的基线和最终评估之间，他的10米步行速度增加了10秒。此外，PF的步态周期的变化后，6周的训练步到位，这表明朝着更对称的步态模式的改善。例如，发现节奏增加，这可能是在10米步行期间步态速度增加之后。还观察到整体步态周期时间减少，双支撑减少，步幅不对称和摆动不对称进一步减少。这些研究结果可能是预期的基础上，以前的工作调查步态康复后的时空参数的变化，并建议，训练步到位概括步行能力。此外，在任何临床评估中均未观察到变化......
Hemiparetic gait due to stroke is characterized by temporal asymmetry and variability. Research shows this can be improved by auditory cueing, whereby participants train to step in time and space with a visual or auditory cue. This particular method is effective in training a symmetrical gait and helps to improve coordination and speed. We describe a pilot study that investigates the possibility of training with an auditory rhythmical metronome embedded in music, during stepping in place within a home- based setting. Stepping in place incorporates aspects of movements that are also important for a successful gait, such as reciprocal flexion and extension of the legs in timely coordination and synchronization, creating a step frequency, a swing phase and single limb support. Stepping in place may also provide a valuable method for home-based training, as little space in the home is required and, therefore, participants are less likely to fall. This case study seeks to obtain proof of the concept that stepping in place within a home setting may be a useful tool for locomotor training after stroke.A hemiparetic stroke patient, PF, successfully completed 6 weeks of home-based training for 15 minutes a day, 5 days a week (with 5% weekly increments in music tempo). PF (aged 58) is a male, right handed, chronic stroke survivor, who presented left sided hemiparesis. He was recruited from a local stroke club based on the inclusion criteria that he was able to walk independently without supervision (but able to use a gait aid such as a cane or walker) and was free from hearing impairments. Finally, PF was also able to complete a 3 m Timed Up and Go, which is typically used as an indicator of falls and provides an indication of the patient's ability during turns. He was assessed five times during the 12 week period of the study, which included baseline, three weeks of training, three weeks of rest (used to measure resting effects), a second three-week training period and finally after another three weeks of rest. During each assessment, PF was tested for his gait speed during a 10 m walking task. During these tests, we also captured the spatiotemporal parameters of his gait using six accelerometer sensors (OPAL, APDM). The sensors were placed around the trunk, the lumbar, and the left and right shins and feet and have been designed to measure walking. The use of such motion capture systems is intended to provide a more sensitive and objective measure of the changes in movement that might occur following gait rehabilitation, compared to the use of standard clinical measures. We also used the following clinical assessments: The Dynamic Gait Index (which measures balance during walking), and The Rivermead Motor Scale (measuring general walking ability).The results showed significant improvements in all spatiotemporal aspects of PF's gait. There was a 10 s speed increase in his 10 m walking, between his baseline and final assessment. Furthermore, changes in PF's gait cycle were shown after 6 weeks of training stepping in place, suggesting improvements towards a more symmetrical gait pattern. For example, an increase in cadence was revealed, which likely follows increases in the gait speed during 10 m walking. A decrease in the overall gait cycle time, decreases in double support, and further decreases in stride length asymmetry and swing asymmetry were also observed. These findings might be expected based on previous work investigating changes in spatiotemporal parameters after gait rehabilitation and suggest that training stepping in place generalizes to walking ability. Furthermore, no changes were observed in any of the clinical assessments …