Pre-swing deficits in forward propulsion, swing initiation and power generation by individual muscles during hemiparetic walking
Pre-swing deficits in forward propulsion, swing initiation and power generation by individual muscles during hemiparetic walking
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DOI：
10.1016/j.jbiomech.2010.04.027
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发表时间：
2010-08-26
影响因子：
2.4
通讯作者：
Neptune, Richard R.
中科院分区：
文献类型：
--
作者：
Peterson, Carrie L.;Hall, Allison L.;Neptune, Richard R.
偏瘫行走的临床研究表明，在轻瘫腿摆动前异常，这表明轻瘫肌肉的重要生物力学行走子任务的贡献是不同于那些非残疾人。两个具有代表性的偏瘫患者的三维正向动力学模拟，其具有通过自我选择的步行速度分类的不同水平的步行功能（即，有限群体=0.4- 0.8m/s和群体步行者= > 0.8m/s）和速度匹配的对照以量化在预摆动阶段期间个体肌肉对向前推进、摆动开始和发电的贡献（即，双支撑阶段进行脚趾离地）。模拟分析确定减少麻痹比目鱼肌和腓肠肌的贡献，向前推进和发电的主要障碍，在有限的社区步行者相比，控制受试者。在有限的社区步行者中，非麻痹腿在前摆时不能补偿麻痹肌肉减少的向前推进力。在社区步行者中，在摆动前，麻痹性肌肉对从麻痹性腿吸收能量有净效应，这表明摆动起始的缺陷是主要的损伤。具体地，麻痹的腓肠肌和髋屈肌（即，髂肌、腰肌和缝匠肌）对摆动起始的贡献较小，并且与对照受试者相比，在团体步行者中，麻痹的比目鱼肌和臀中肌从麻痹的腿吸收更多的动力。旨在减少这些缺陷的康复策略有很大的潜力，以改善这些偏瘫患者的行走功能和那些类似的缺陷。(C)2010爱思唯尔有限公司保留所有权利。
Clinical studies of hemiparetic walking have shown pre-swing abnormalities in the paretic leg suggesting that paretic muscle contributions to important biomechanical walking subtasks are different than those of non-disabled individuals. Three-dimensional forward dynamics simulations of two representative hemiparetic subjects with different levels of walking function classified by self-selected walking speed (i.e., limited community=0.4-0.8 m/s and community walkers= > 0.8 m/s) and a speed-matched control were generated to quantify individual muscle contributions to forward propulsion, swing initiation and power generation during the pre-swing phase (i.e., double support phase proceeding toe-off). Simulation analyses identified decreased paretic soleus and gastrocnemius contributions to forward propulsion and power generation as the primary impairment in the limited community walker compared to the control subject. The non-paretic leg did not compensate for decreased forward propulsion by paretic muscles during pre-swing in the limited community walker. Paretic muscles had the net effect to absorb energy from the paretic leg during pre-swing in the community walker suggesting that deficits in swing initiation are a primary impairment. Specifically, the paretic gastrocnemius and hip flexors (i.e., iliacus, psoas and sartorius) contributed less to swing initiation and the paretic soleus and gluteus medius absorbed more power from the paretic leg in the community walker compared to the control subject. Rehabilitation strategies aimed at diminishing these deficits have much potential to improve walking function in these hemiparetic subjects and those with similar deficits. (C) 2010 Elsevier Ltd. All rights reserved.