Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: Preliminary report
Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: Preliminary report
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DOI：
10.1186/1471-2377-5-3
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发表时间：
2005-02-18
期刊：
影响因子：
2.6
通讯作者：
Wolf, SL
中科院分区：
文献类型：
--
作者：
McGibbon, CA;Krebs, DE;Wolf, SL
背景：前庭康复（VR）是一种被广泛接受的锻炼计划，旨在纠正由周围前庭系统损伤引起的平衡障碍。替代疗法，如太极（TC），最近作为一种治疗平衡障碍的方法而受到欢迎。尽管VR和TC可以使患有前庭病变的人受益，但步态改善的程度可能与下肢对两种不同疗法的神经肌肉适应有关。方法：我们研究了36名患有前厅神经病变的老年人下肢神经肌肉功能和躯干控制之间的关系，随机分为10周的VR或TC运动。测量时间-距离测量（步态速度、步长、站立时间和步宽）、下肢矢状面机械能消耗（MEE）、躯干矢状面和正面运动学（线速度和角速度的峰值和范围）。结果：虽然治疗后两组的步态时间-距离测量均有所改善，但MEE和躯干运动学测量在组间无显著差异。然而，在组内观察到显著的变化。TC组显著增加了踝关节MEE的贡献，降低了髋部MEE对总腿部MEE的贡献，而VR组没有发现显著变化。TC组腿部MEE变化与躯干速度峰值和范围变化呈正相关，VR组呈负相关。结论：两组患者的步态功能改善与干预预期一致。各组对治疗反应的差异似乎表明，步态功能的改善可能是由于不同干预导致的不同神经肌肉适应。TC组的改善与下肢神经肌肉模式的重组有关，这似乎促进了更快的步态，减少了过度的髋关节代偿。然而，VR组的改善并不是下肢神经肌肉模式改变的结果。在VR组中，下肢MEE增加与躯干前向线性和角度运动减弱相对应，表明上身运动控制更好，以减少平衡损失。这些数据支持越来越多的证据表明，太极拳可能是前庭疾病的一种有价值的补充治疗。
Background: Vestibular rehabilitation (VR) is a well-accepted exercise program intended to remedy balance impairment caused by damage to the peripheral vestibular system. Alternative therapies, such as Tai Chi (TC), have recently gained popularity as a treatment for balance impairment. Although VR and TC can benefit people with vestibulopathy, the degree to which gait improvements may be related to neuromuscular adaptations of the lower extremities for the two different therapies are unknown.Methods: We examined the relationship between lower extremity neuromuscular function and trunk control in 36 older adults with vestibulopathy, randomized to 10 weeks of either VR or TC exercise. Time-distance measures ( gait speed, step length, stance duration and step width), lower extremity sagittal plane mechanical energy expenditures ( MEE), and trunk sagittal and frontal plane kinematics ( peak and range of linear and angular velocity), were measured.Results: Although gait time-distance measures were improved in both groups following treatment, no significant between-groups differences were observed for the MEE and trunk kinematic measures. Significant within groups changes, however, were observed. The TC group significantly increased ankle MEE contribution and decreased hip MEE contribution to total leg MEE, while no significant changes were found within the VR group. The TC group exhibited a positive relationship between change in leg MEE and change in trunk velocity peak and range, while the VR group exhibited a negative relationship.Conclusion: Gait function improved in both groups consistent with expectations of the interventions. Differences in each group's response to therapy appear to suggest that improved gait function may be due to different neuromuscular adaptations resulting from the different interventions. The TC group's improvements were associated with reorganized lower extremity neuromuscular patterns, which appear to promote a faster gait and reduced excessive hip compensation. The VR group's improvements, however, were not the result of lower extremity neuromuscular pattern changes. Lower-extremity MEE increases corresponded to attenuated forward trunk linear and angular movement in the VR group, suggesting better control of upper body motion to minimize loss of balance. These data support a growing body of evidence that Tai Chi may be a valuable complementary treatment for vestibular disorders.