Does the Environment Cause Changes in Hemiparetic Lower Limb Muscle Activity and Gait Velocity During Walking in Stroke Survivors?
Does the Environment Cause Changes in Hemiparetic Lower Limb Muscle Activity and Gait Velocity During Walking in Stroke Survivors?
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105174
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发表时间：
2020-10-01
影响因子：
2.5
通讯作者：
Kumaran, Senthil D.
中科院分区：
文献类型：
--
作者：
D'souza, Jennifer;Natarajan, Manikandan;Kumaran, Senthil D.
中风幸存者在社区活动中经常面临困难，尽管他们在临床设置中获得了稳定的行走状态。环境的顺应性和不可预测性可能会改变肌肉活动和挑战个人的步态。成功地重新融入社会需要步态评估和训练在现实生活中具有挑战性的环境。在具有挑战性的活动维度下，社区环境中步态的评估和训练鲜为人知。因此，我们的目的是研究现实生活中的环境因素对偏瘫下肢选定肌肉活动和中风幸存者步态速度的影响。方法：一项观察性横断面研究对16名步行卒中幸存者进行了评估，以评估在真实环境维度下行走时偏瘫下肢肌肉活动。参与者被要求在一条由平坦的路面、坡道、楼梯、不平坦的地形和障碍物组成的人行道上行走。他们还被要求在车流中穿行，并在人行道上行走一段距离时选择货物。采用无线面肌电图连续记录瘫瘫下肢股直肌、股二头肌、腓肠肌内侧肌和胫前肌的肌肉活动。此外，还测量了受试者在不同维度行走时的步态速度和感知困难程度。采用配对t检验比较行走时，下肢肌肉最大自主收缩百分比（%MVC）在均匀表面和真实环境维度之间的差异。采用单样本t检验比较了现实生活维度的步态速度与早期研究中测量的均匀表面的步态速度。结果：与平坦地面相比，在真实环境维度影响下行走时，所有四个偏瘫下肢肌肉的活动均显著减少（p < 0.01）。步态速度（0.33 +/- 0.17 m/s）明显低于成为社区步行车所必需的速度。所有维度的感知难度水平定性地报告了在楼梯和障碍清除期间报告的最高难度。结论：现实生活的环境因素导致社区居住的中风幸存者在行走时麻痹性下肢肌肉活动和步态速度的减少。中风幸存者认为在现实生活中行走更困难，尤其是在通过楼梯和障碍物时。意义：了解现实生活环境维度的影响，有助于临床医生有针对性地采用康复方法提高行走适应性。
Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a reallife challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors. Methods: An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study. Results: There was a significant reduction (p < 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 +/- 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance. Conclusion: Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles. Significance: Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.