Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke
Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke
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DOI：
10.1016/s0003-9993(03)00030-3
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发表时间：
2003-08-01
影响因子：
4.3
通讯作者：
Jan, MH
中科院分区：
文献类型：
--
作者：
Hsu, AL;Tang, PF;Jan, MH
目的：探讨影响轻中度脑卒中患者步态速度和不对称性的最重要因素。设计：便利样本描述性分析。地点：台湾某医院康复门诊。参与者：26名在单次中风发作后患有轻度至中度痉挛性偏瘫的受试者，所有受试者都能够独立行走，无需任何辅助或设备。干预措施：不适用。主要观察指标：受试者的最大肌力（等速峰值扭矩、总功）、运动和感觉功能以及患下肢踝关节跖屈肌痉挛分别采用Cybex 6000测力仪、Fugl-Meyer评估和修正Ashworth量表进行检测。当受试者以舒适和快速的速度行走时，使用GailMatII评估步态速度以及时间和空间不对称性。结果：回归分析显示，受影响的髋屈肌和膝关节伸肌的总工作等速测量分别是舒适和快速步态速度的最重要的独立决定因素（R-2= 0.57, R-2= 0.72）。在舒适速度（时间不对称的R-2= 0.76，空间不对称的R-2= 0.46）和快速（时间不对称的R-2= 0.75，空间不对称的R-2= 0.45）步行时，受影响的跖屈肌的痉挛是时空步态不对称的最重要的独立决定因素。结论：轻中度脑卒中患者的步态速度和不对称性受到不同身体损伤的影响。步态速度主要受髋关节屈肌和膝关节伸肌无力的影响，而步态不对称主要受踝关节跖屈肌痉挛程度的影响。旨在改善这些患者步态表现的不同方面的治疗干预可能强调对不同损伤的治疗。(C) 2003年由美国康复医学大会和美国物理医学与康复学会颁发。
Objective: To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke.Design: Descriptive analysis of convenience sample.Setting: Outpatient rehabilitation clinic of a hospital in Taiwan.Participants: Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device.Interventions: Not applicable.Main Outcome Measures: Subjects' maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GailMatII.Results: Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R-2=.57, R-2=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R-2=.76 for temporal asymmetry; R-2=.46 for spatial asymmetry) and fast-speed (R-2=.75 for temporal asymmetry; R-2=.45 for spatial asymmetry) walking.Conclusions: Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments. (C) 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.