Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke
Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke
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DOI：
10.1310/tsr1804-293
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发表时间：
2011-07-01
影响因子：
2.2
通讯作者：
Narducci, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Hornby, T. George;Straube, Donald S.;Narducci, Elizabeth A.
尽管残障会导致行走速度减慢、时空不对称、步态效率低下以及在家庭和社区中行走活动受限，但大多数中风后患者都能恢复地上行走能力。大量的研究调查了各种干预措施对个体中风后运动功能的影响；这些研究在练习任务的类型、练习活动的数量以及干预期间的强度或工作量方面差异很大。相比之下，基础研究和应用研究已经确定了可用于中风后患者治疗的训练的具体参数。更直接的是，步行练习的特异性、数量和强度被认为是康复干预的关键变量，可以促进神经肌肉和心肺系统的可塑性，并改善运动功能。在目前的评论中，我们描述了提供大量高强度运动训练以改善个体中风后行走功能的证据和生理学原理。其他证据表明，在运动训练后，非步行任务（如静态平衡和转移性能）的改善也可能发生。我们在这些参数的背景下进一步评估了以前和最近的研究，并为在临床环境中为中风患者提供运动训练提供建议。
The majority of individuals poststroke recover the ability to walk overground, although residual impairments contribute to reduced walking speed, spatiotemporal asymmetries, inefficient gait, and limited walking activity in the home and community. A substantial number of studies have investigated the effects of various interventions on locomotor function in individuals poststroke; these studies vary widely in types of tasks practiced, the amount of practiced activities, and the intensity or workload during the intervention. In contrast, basic and applied studies have identified specific parameters of training that could be applied towards treatment of patients poststroke. More directly, the specificity, amount, and intensity of walking practice are thought to be critical variables of rehabilitation interventions that can facilitate plasticity of neuromuscular and cardiopulmonary systems and result in improved locomotor function. In the present commentary, we delineate the evidence and physiological rationale for providing large amounts of high-intensity locomotor training to improve ambulatory function in individuals poststroke. Additional evidence is presented to indicate that improvements in non-walking tasks, such as static balance and performance of transfers, may also occur following locomotor training. We further evaluate previous and more recent studies in the context of these parameters and provide suggestions for providing locomotor training for patients with stroke in the clinical setting.