The Presence of a Paretic Propulsion Reserve During Gait in Individuals Following Stroke
The Presence of a Paretic Propulsion Reserve During Gait in Individuals Following Stroke
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DOI：
10.1177/1545968318809920
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发表时间：
2018-12-01
影响因子：
4.2
通讯作者：
Doty, Amanda
中科院分区：
文献类型：
--
作者：
Lewek, Michael D.;Raiti, Cristina;Doty, Amanda
背景资料。中风后残存的偏瘫导致步态中推进力的单侧减少。先前的研究表明，瘫痪肢体中存在推进储备。目标。这项研究的目的是量化卒中后患者的偏瘫推进储备，并确定偏瘫肢体额外推进力产生的生物力学机制。方法：研究方法。10名中风后慢性偏瘫患者在跑步机上行走，承受施加在身体质心上的阻碍力(以2.5%的体重增量上升0%至10%的体重，然后下降10%至0%的体重，同样以2.5%的体重增量)。所产生的推进力是双侧测量的，并在阻滞力水平之间进行比较。然后，我们评估了潜在的机制(后肢角度和足屈力矩)，潜在的推进变化。结果。总体而言，瘫痪患者的峰值推进力增加了92%，瘫痪患者的推进冲量增加了225%，导致瘫痪肢体对推进的贡献显著增加。受试者在去除阻碍力后，继续产生更多的偏瘫推进力。后肢角度对偏瘫患者推进力的增加有显著贡献，而足屈力矩对此无显著影响。结论。参与者在瘫痪肢体上表现出强大的推进储备，这表明可以通过康复来挖掘尚未开发的潜力，以改善步态恢复。推进对称性的增加表明，偏瘫肢体的反应比非偏瘫肢体的补偿增加更大。
Background. The residual hemiparesis after stroke results in a unilateral reduction in propulsive force during gait. Prior work has suggested the presence of a propulsive reserve in the paretic limb. Objective. The purpose of this study was to quantify the paretic propulsive reserve in individuals poststroke and to determine the biomechanical mechanism underlying the generation of additional paretic propulsive limb force. Methods. Ten individuals with chronic hemiparesis poststroke walked on a treadmill against an impeding force (ascending 0% to 10% body weight [BW], in 2.5% BW increments, followed by descending 10% to 0% BW, also in 2.5% BW increments) applied to the body's center of mass. The resulting propulsive forces were measured bilaterally and compared between impeding force levels. We then assessed potential mechanisms (trailing limb angle and plantarflexion moment) underlying the changes in propulsion. Results. Overall, peak paretic propulsive force increased by 92% and the paretic propulsive impulse increased by 225%, resulting in a significant increase in the paretic limb's contribution to propulsion. Participants continued to produce increased paretic propulsion on removal of the impeding force. The trailing limb angle contributed significantly to the increase in paretic propulsion, whereas the plantarflexion moment did not. Conclusions. Participants exhibited a robust propulsive reserve on the paretic limb, suggesting that there is untapped potential that can be exploited through rehabilitation to improve gait recovery. The increase in propulsive symmetry indicates that a greater response was observed by the paretic limb rather than increased compensation by the nonparetic limb.