Locomotor Kinematics and Kinetics Following High-Intensity Stepping Training in Variable Contexts Poststroke
Locomotor Kinematics and Kinetics Following High-Intensity Stepping Training in Variable Contexts Poststroke
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DOI：
10.1177/1545968320929675
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发表时间：
2020-06-06
影响因子：
4.2
通讯作者：
Hornby, T. George
中科院分区：
文献类型：
--
作者：
Ardestani, Marzieh M.;Henderson, Christopher E.;Hornby, T. George
背景和目的。先前的研究表明，中风后个体可以通过高强度运动训练（LT）获得显著的步行功能改善。最近的研究结果还表明，针对运动缺陷的可变步进任务的实践可以减轻步行速度降低所导致的某些损伤。本研究的目的是研究三种不同的LT模式下运动生物力学的变化。方法。这是一项随机试验的二次分析，招募了18至85岁、中风后6个月的患者。我们比较了30次针对四肢麻痹和平衡障碍（high-variable， HV）的可变任务的高强度（bb0 - 70%心率储备[HRR]） LT、只专注于向前行走的高强度LT （high-forward， HF）或低强度LT （= 0.1 m/s的电动跑步机）后的时空、关节运动学和动力学变化。HV、HF和LV在时空参数、运动一致性和动力学方面存在显著差异。所得主成分分析的特征是在HV后的亲性幂和运动一致性，而HF和LV的特征是非亲性幂。结论。与低强度干预相比，高强度LT会导致更大的运动学和动力学变化。结果可能表明，针对特定生物力学缺陷的高强度可变步进训练对四肢损伤的贡献更大。临床试验注册。唯一标识符：NCT02507466
Background and Purpose. Previous studies suggest that individuals poststroke can achieve substantial gains in walking function following high-intensity locomotor training (LT). Recent findings also indicate practice of variable stepping tasks targeting locomotor deficits can mitigate selected impairments underlying reduced walking speeds. The goal of this study was to investigate alterations in locomotor biomechanics following 3 different LT paradigms. Methods. This secondary analysis of a randomized trial recruited individuals 18 to 85 years old and >6 months poststroke. We compared changes in spatiotemporal, joint kinematics, and kinetics following up to 30 sessions of high-intensity (>70% heart rate reserve [HRR]) LT of variable tasks targeting paretic limb and balance impairments (high-variable, HV), high-intensity LT focused only on forward walking (high-forward, HF), or low-intensity LT (= 0.1 m/s on a motorized treadmill. Significant differences in spatiotemporal parameters, kinematic consistency, and kinetics were observed between HV and HF versus LV. Resultant principal component analyses were characterized by paretic powers and kinematic consistency following HV, while HF and LV were characterized by nonparetic powers. Conclusion. High-intensity LT results in greater changes in kinematics and kinetics as compared with lower-intensity interventions. The results may suggest greater paretic-limb contributions with high-intensity variable stepping training that targets specific biomechanical deficits. Clinical Trial Registration. Unique Identifier: NCT02507466