Forward propulsion asymmetry is indicative of changes in plantarflexor coordination during walking in individuals with post-stroke hemiparesis
Forward propulsion asymmetry is indicative of changes in plantarflexor coordination during walking in individuals with post-stroke hemiparesis
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DOI：
10.1016/j.clinbiomech.2014.06.001
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发表时间：
2014-08-01
影响因子：
1.8
通讯作者：
Neptune, Richard R.
中科院分区：
文献类型：
--
作者：
Allen, Jessica L.;Kautz, Steven A.;Neptune, Richard R.
背景资料：中风后康复有效性的一个常见指标是自我选择的步行速度，但个人可能会使用不同的协调策略来实现相同的速度。每条腿产生的推进力的不对称性可以提供对麻痹腿协调的洞察，因为其与偏瘫严重程度的相对强的相关性。以相同速度行走的受试者可以表现出不同的推进不对称性，一些受试者更多地依赖于麻痹腿，而另一些受试者则依赖于非麻痹腿。本研究的目的是评估是否分析推进不对称性可以帮助区分改善轻瘫腿协调与nonpaletic leg compensation.Methods：三维正向动力学模拟开发了两个中风后偏瘫患者以相同的速度行走前/后康复与推进不对称性相反的变化。在个人的肌肉贡献向前推进的变化进行了examined.Findings：在这两个科目的主要来源增加向前推进是从踝跖屈肌。它们的使用方式不同，似乎与推进不对称的变化有关。受试者A增加了麻痹性跖屈肌产生的推进力，而受试者B增加了非麻痹性跖屈肌产生的推进力。每个受试者提高速度的策略还包括其他肌肉群的差异（例如，腿筋），似乎并没有与推进不对称。解释：这项研究的结果强调了如何速度不能用来阐明潜在的肌肉协调变化后康复。与此相反，推进不对称似乎提供了深入了解跖屈肌输出的变化影响推进发电，并可能是有用的监测康复的结果。(C)2014爱思唯尔有限公司版权所有。
Background: A common measure of rehabilitation effectiveness post-stroke is self-selected walking speed, yet individuals may achieve the same speed using different coordination strategies. Asymmetry in the propulsion generated by each leg can provide insight into paretic leg coordination due to its relatively strong correlation with hemiparetic severity. Subjects walking at the same speed can exhibit different propulsion asymmetries, with some subjects relying more on the paretic leg and others on the nonparetic leg. The goal of this study was to assess whether analyzing propulsion asymmetry can help distinguish between improved paretic leg coordination versus nonparetic leg compensation.Methods: Three-dimensional forward dynamics simulations were developed for two post-stroke hemiparetic subjects walking at identical speeds before/after rehabilitation with opposite changes in propulsion asymmetry. Changes in the individual muscle contributions to forward propulsion were examined.Findings: The major source of increased forward propulsion in both subjects was from the ankle plantarflexors. How they were utilized differed and appears related to changes in propulsion asymmetry. Subject A increased propulsion generated from the paretic plantarflexors, while Subject B increased propulsion generated from the nonparetic plantarflexors. Each subject's strategy to increase speed also included differences in other muscle groups (e.g., hamstrings) that did not appear to be related to propulsion asymmetry.Interpretation: The results of this study highlight how speed cannot be used to elucidate underlying muscle coordination changes following rehabilitation. In contrast, propulsion asymmetry appears to provide insight into changes in plantarflexor output affecting propulsion generation and may be useful in monitoring rehabilitation outcomes. (C) 2014 Elsevier Ltd. All rights reserved.