ASSESSMENT OF GAIT AND MOBILITY IN THE ELDERLY
ASSESSMENT OF GAIT AND MOBILITY IN THE ELDERLY
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DOI：
10.1093/ageing/8.4.261
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发表时间：
1979-01-01
期刊：
影响因子：
6.7
通讯作者：
EDHOLM, OG
中科院分区：
文献类型：
--
作者：
IMMS, FJ;EDHOLM, OG
如果我们观察一个人走路，我们都可以很快判断这个人是否以正常的步态前进，或者步态是否不正常。如果我们确定步态是不正常的，那么我们通常很难确定它到底有什么问题，我们需要能够“冻结”动作，以便我们可以检查一个步幅或一系列步幅的连续组成部分。我们对步态的可视化通常可以通过步行周期中事件的图形表示来帮助。执行此任务的经典方法是通过拍摄主题的电影胶片，然后分析各个帧。从这样的影片中，步态可以通过测量每个帧中的躯干-大腿角度或大腿-胫部角度并将这些与步行周期的阶段相关联来量化。躯干和大腿之间的角度（代表髋关节的运动）与大腿和小腿之间的角度（代表膝关节的屈曲和伸展）的绘图，产生了每个完整步行周期的循环图（图1）。如果在几个周期内绘制曲线图，受试者在平坦的地形上以恒定的速度行走，那么每个周期的循环应该是相似的（Grieve 1969）。步态的外展会改变环的形状。举一个极端的例子，一个膝关节固定术患者的步态将由一条水平线表示。使用偏振光测角仪（Mitchelson 1973）可以更容易地获得相同的信息。偏振光传感器被放置在受试者的大腿和小腿上，然后受试者穿过一束偏振光。光在传感器上的入射角在步行过程中是变化的，XY轴可以用来产生一个回路图，这样的技术可以提供关于步态形式的有用信息，但不能提供关于步行速度的信息，也不能提供简单的因素，如步长和步进频率。该信息可通过使用金属走道来获得，受试者在金属走道上行走，其鞋后跟和鞋底上有金属箔接触（图2）。每次脚跟或鞋底接触走道时，一个回路就完成了，并将事件记录在紫外线纸上。此外，有两个光束穿过人行道，激活光电管。行走的速度可以从受试者断开两个射束之间的间隔来计算。步态的对称性可以通过比较双脚的接触时间、双腿的摆动阶段或双腿的半步时间来检查。这项技术已被用来评估改善步态在一组年轻的
If we observe a person walking, we can all quickly pass a judgement on whether the person is progressing with a normal gait or whether the gait is abnormal. If we decide that the gait is abnormal then we often find it difficult to decide exactly what is wrong with it. We need to be able to'freeze'the action so that we can examine the serial components of a stride or series of strides. Our visualization of the gait can often be aided by graphical representation of events in the walking cycle. The classical method of performing this task is by taking cine film of the subject and then analysing individual frames. From such film the gait may be quantified by measuring the trunk-thigh angles or the thigh-shin angles in each frame and relating these to the stage of the walking cycle. The plotting of the angle between trunk and thigh, representing movement at the hip joint, against the angle between thigh and lower leg, representing flexion and extension of the knee joint, yields a loop diagram for each complete walking cycle (Fig. 1). If the graphs are plotted over several cycles, with the subject walking at constant speed on an even terrain, then the loops for each cycle should be similar (Grieve 1969). Abnormalities of the gait will produce alterations in the shape of the loop. To take an extreme example, the gait of a person with an arthrodesis of the knee would be represented by a horizontal line. The same information may be obtained more easily using the polarized-light goniometer (Mitchelson 1973). Sensors to polarized light are placed on the thigh and shin of the subject who then walks through a beam of polarized light. The angles of incidence of the light on the sensors vary during the walking cycle, and an XY plotter is used to produce a loop diagram.Such techniques give much useful information about the form of the gait, but none about the speed of walking, or of simple factors such as stride length and frequency of stepping. This information may be obtained by using a metal walkway on which the subject walks in shoes with metal foil contacts on the heels and soles of his shoes (Fig. 2). Each time that a heel or sole is in contact with the walkway a circuit is completed and the event recorded on ultraviolet paper. In addition, there are two light beams crossing the walkway which activate photocells. The velocity of walking may be calculated from the interval between the subject breaking the two beams. Symmetry of the gait may be examined by comparing the times of contact of the two feet, the swing phases of the two legs, or the half-pace times for the legs. This technique has been used to assess improvements of gait in a group of young