The Next Step in Understanding Impaired Reactive Balance Control in People With Stroke: The Role of Defective Early Automatic Postural Responses.
The Next Step in Understanding Impaired Reactive Balance Control in People With Stroke: The Role of Defective Early Automatic Postural Responses.
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DOI：
10.1177/1545968317718267
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发表时间：
2017-08
影响因子：
4.2
通讯作者：
Weerdesteyn V
中科院分区：
文献类型：
--
作者：
de Kam D;Roelofs JMB;Bruijnes AKBD;Geurts ACH;Weerdesteyn V
背景和目标。中风后姿势性肌肉反应经常受损。我们的目的是确定赤字的贡献，在非常早期的姿势反应较差的反应性平衡能力，特别关注反应性步进作为一个关键的战略，以避免福尔斯。方法.共34名慢性卒中幸存者和17名对照者在4个方向上受到平移平衡扰动。我们确定了无需步进（单步阈值[SST]）和最多1步（多步阈值[MST]）即可恢复的最高扰动强度。我们确定了双侧7条腿肌肉的起始潜伏期和反应幅度，并确定了与平衡能力的相关性。结果中风患者在各个方向的MST都低于对照组。侧步比交叉步导致更高的横向MST，但对麻痹侧不太常见。仅麻痹侧的姿势反应延迟且幅度较小。我们观察到臀中肌（GLUT）的起始和振幅与MST向麻痹侧的最强关联（R2 = 0.33）。肌电图变量与前向和后向MST（R2 = 0.10-0.22）和SST（R2 = 0.08-0.15）的相关性相当弱。结论.延迟和减少的麻痹姿势反应与中风后反应性踏步受损有关。特别是，GLUT的快速和有力的活动对于克服大的侧向扰动是必不可少的，大概是因为它有助于有效地使用侧步。由于中风患者通常会向轻瘫一侧倒下，这一发现表明了训练的一个重要目标。
Background and objective. Postural muscle responses are often impaired after stroke. We aimed to identify the contribution of deficits in very early postural responses to poorer reactive balance capacity, with a particular focus on reactive stepping as a key strategy for avoiding falls. Methods. A total of 34 chronic stroke survivors and 17 controls were subjected to translational balance perturbations in 4 directions. We identified the highest perturbation intensity that could be recovered without stepping (single stepping threshold [SST]) and with maximally 1 step (multiple stepping threshold [MST]). We determined onset latencies and response amplitudes of 7 leg muscles bilaterally and identified associations with balance capacity. Results. People with stroke had a lower MST than controls in all directions. Side steps resulted in a higher lateral MST than crossover steps but were less common toward the paretic side. Postural responses were delayed and smaller in amplitude on the paretic side only. We observed the strongest associations between gluteus medius (GLUT) onset and amplitude and MST toward the paretic side (R2 = 0.33). Electromyographic variables were rather weakly associated with forward and backward MSTs (R2 = 0.10-0.22) and with SSTs (R2 = 0.08-0.15). Conclusions. Delayed and reduced paretic postural responses are associated with impaired reactive stepping after stroke. Particularly, fast and vigorous activity of the GLUT is imperative for overcoming large sideways perturbations, presumably because it facilitates the effective use of side steps. Because people with stroke often fall toward the paretic side, this finding indicates an important target for training.
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影响因子：
2.4
作者：
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DOI：
10.1111/j.1532-5415.2005.53158.x
发表时间：
2005-03-01
影响因子：
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作者：
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通讯作者：
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