Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke
Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke
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DOI：
10.1093/ptj/pzaa109
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发表时间：
2020-09-01
期刊：
影响因子：
3.2
通讯作者：
Rogers, Mark W.
中科院分区：
文献类型：
--
作者：
Gray, Vicki L.;Fujimoto, Masahiro;Rogers, Mark W.
目标。中风后因外界干扰或随意运动而失去平衡的情况通常可以通过踏步来恢复。本研究的目的是研究社区居民慢性中风跌倒患者和非跌倒患者在侧向腰部牵拉扰动和自愿行走时的踩踏行为特征。这项研究采用了队列设计。30名卒中后6个月的受试者接受了24次外部触发的侧向腰部拉动和20次自愿步法。确定了平衡耐力极限(BTL)(从单步到多步的过渡)和第一步类型。计算了起爆时间、起爆速度、起爆第一步长度、起爆间隙等参数。评估6个月前发生的髋外展肌/内收肌扭矩、足部皮肤感和自我报告的跌倒情况。12名参与者被追溯归类为跌倒者，18名参与者被归类为不跌倒者。与不跌倒的人相比，跌倒的人BTL减少，第一步走得更中间。在BTL以上，在内侧台阶上没有发现组间差异。在BTL，跌倒患者的非轻瘫台阶间隙减少。在BTL以上，与非跌倒者相比，跌倒者启动偏瘫和非轻瘫步骤所需的时间更长，非轻瘫步长和间隙更小。截瘫患者双腿主动踏步的起始时间存在组间差异(P<；0.05)。跌倒患者的偏瘫外展肌扭矩减少，偏瘫足部皮肤感觉受损。中风后较高的跌倒发生率需要有效的跌倒预防策略。鉴于跌倒运动员与非跌倒运动员在摄动诱导踏步过程中的差异较大，需要进一步研究评估摄动训练对减少跌倒的作用。在确定跌倒风险时，跌倒评估应包括外部诱导的扰动以及自愿移动。
Objective. A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke.Methods. This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated.Results. Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation.Conclusion. A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed.Impact. Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.