The role of limb movements in maintaining upright stance: The ''change-in-support'' strategy
The role of limb movements in maintaining upright stance: The ''change-in-support'' strategy
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DOI：
10.1093/ptj/77.5.488
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发表时间：
1997-05-01
期刊：
影响因子：
3.2
通讯作者：
McIlroy, WE
中科院分区：
文献类型：
--
作者：
Maki, BE;McIlroy, WE
改变的支持策略，涉及的四肢的步进或抓运动，是普遍的反应不稳定，似乎发挥更重要的功能作用，在保持直立的立场比一般被赞赏。与传统观点相反，支撑变化反应不仅仅是最后的策略，而且通常在质心接近支撑基础的稳定极限之前就开始了。此外，似乎受试者，当给予选择，将选择这些反应优先于固定支持的“髋关节策略”，一直声称是功能的重要性。快速的补偿性支撑变化反应将它们与“意志性”的手臂和腿部运动区分开来。此外，代偿性踏步反应通常缺乏非代偿性踏步中始终存在的预期控制元素，例如步态启动。即使存在，这些预期的调整似乎在快速代偿运动中也没有什么功能价值。后期失稳使代偿性踏步控制复杂化，这一发现可能与老年人的福尔斯跌倒和髋部骨折问题特别相关。老年人似乎黑尔控制横向稳定性的问题时，加强恢复平衡，即使在响应前后扰动。增加对支撑反应变化的理解和认识应导致开发新的诊断和治疗方法，以检测和治疗老年人和平衡障碍患者失衡和跌倒的具体原因。
Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support ''hip strategy'' that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from ''volitional'' arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Later al destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to hale problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments.