Combining muscle synergies and biomechanical analysis to assess gait in stroke patients
Combining muscle synergies and biomechanical analysis to assess gait in stroke patients
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DOI：
10.1016/j.jbiomech.2017.08.006
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发表时间：
2017-10-03
影响因子：
2.4
通讯作者：
Pons, Jose L.
中科院分区：
文献类型：
--
作者：
Barroso, Filipe O.;Torricelli, Diego;Pons, Jose L.
了解脑卒中后步态的生物力学缺陷和神经控制受损对于制定有效的定制治疗方案以改善步行功能至关重要。仪器步态分析越来越多地融入临床实践，以提高病理步态评估的准确性和可靠性。另一方面，肌肉协同作用的分析作为一种描述步行神经控制的新工具已经获得了相关性。由于肌肉协同作用和步态分析捕获了行走不同但同样重要的方面，我们假设它们的结合可以改善目前评估行走表现的临床工具。为了验证这一假设，我们对9名中风后偏瘫患者在地上行走时进行了完整的双侧、下肢生物力学和肌肉协同分析。通过逐步多元回归，我们从麻痹侧和非麻痹侧确定了许多运动学、动力学、时空和协同相关的特征，这些特征结合在一起，可以比Fugl-Meyer评估评分更好地预测行走功能受损。这些变量包括膝关节峰值屈曲时间、VAF（总）值、站立阶段持续时间、paretic推进峰值和髋关节屈曲范围。由于这五个变量描述了中风后行走缺陷的重要生物力学和神经控制特征，因此它们可能可以驱动旨在改善行走功能的定制康复治疗。本文论证了结合生物力学和神经相关测量来评估神经损伤个体运动表现的可行性。(C) 2017 Elsevier Ltd.版权所有。
The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance.To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAF(total) values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function.This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals. (C) 2017 Elsevier Ltd. All rights reserved.