Relationships between muscle contributions to walking subtasks and functional walking status in persons with post-stroke hemiparesis
Relationships between muscle contributions to walking subtasks and functional walking status in persons with post-stroke hemiparesis
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DOI：
10.1016/j.clinbiomech.2010.12.010
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发表时间：
2011-06-01
影响因子：
1.8
通讯作者：
Neptune, R. R.
中科院分区：
文献类型：
--
作者：
Hall, A. L.;Peterson, C. L.;Neptune, R. R.
背景：脑卒中后偏瘫患者通常行走缓慢且不对称。脑卒中严重程度和功能性步行状态通常由脑卒中后步行速度预测。需要了解限制行走速度的机制，并通过扩展功能行走状态，以改善卒中后康复方法。方法：对不同功能行走状态的偏瘫受试者（及速度匹配对照）进行三维正向动力学模拟，研究肌肉对行走子任务的贡献与功能行走状态之间的关系。在步态周期的摇摆前阶段，分析肌肉对向前推进、摇摆起始和发电的贡献，并比较两组之间的差异。研究结果：瘫腿肌（比目鱼肌、腓肠肌和臀中肌）对向前推进力的贡献随着功能性步行状态的改善而增加，而非瘫腿肌（股直肌和腹肌）补偿了有限社区步行者瘫腿推进力的减少。轻瘫（即腓肠肌、髂肌和腰肌）和非轻瘫腿部肌肉（即腘绳肌）对摇摆起始的贡献也随着功能行走状态的改善而增加。发电量也是功能性行走状态的重要指标，paretic腿发电量的减少限制了paretic腿对向前推进和腿部摆动的贡献。解释：这些结果表明，参与向前推进、摇摆启动和发电等行走子任务的肌肉缺陷与功能性行走状态直接相关，改善这些肌肉群的输出可能是改善中风后偏瘫行走的有效康复策略。(C) 2010 Elsevier Ltd.版权所有。
Background: Persons with post-stroke hemiparesis usually walk slowly and asymmetrically. Stroke severity and functional walking status are commonly predicted by post-stroke walking speed. The mechanisms that limit walking speed, and by extension functional walking status, need to be understood to improve post-stroke rehabilitation methods.Methods: Three-dimensional forward dynamics walking simulations of hemiparetic subjects (and speed-matched controls) with different levels of functional walking status were developed to investigate the relationships between muscle contributions to walking subtasks and functional walking status. Muscle contributions to forward propulsion, swing initiation and power generation were analyzed during the pre-swing phase of the gait cycle and compared between groups.Findings: Contributions from the paretic leg muscles (i.e., soleus, gastrocnemius and gluteus medius) to forward propulsion increased with improved functional walking status, with the non-paretic leg muscles (i.e., rectus femoris and vastii) compensating for reduced paretic leg propulsion in the limited community walker. Contributions to swing initiation from both paretic (i.e., gastrocnemius, iliacus and psoas) and non-paretic leg muscles (i.e., hamstrings) also increased as functional walking status improved. Power generation was also an important indicator of functional walking status, with reduced paretic leg power generation limiting the paretic leg contribution to forward propulsion and leg swing initiation.Interpretation: These results suggest that deficits in muscle contributions to the walking subtasks of forward propulsion, swing initiation and power generation are directly related to functional walking status and that improving output in these muscle groups may be an effective rehabilitation strategy for improving post-stroke hemiparetic walking. (C) 2010 Elsevier Ltd. All rights reserved.