A method to differentiate the causes of stiff-knee gait in stroke patients
A method to differentiate the causes of stiff-knee gait in stroke patients
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DOI：
10.1016/j.gaitpost.2013.05.003
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发表时间：
2013-06-01
期刊：
影响因子：
2.4
通讯作者：
Damiano, B.
中科院分区：
文献类型：
--
作者：
Campanini, I.;Merlo, A.;Damiano, B.
僵膝步态(SKG)是卒中后常见的一种异常步态，其特征是摆动时膝关节屈曲不足。股直肌(RF)活动过度被认为是SKG的主要原因。在最近的文献中，不充分的推离被认为是另一个原因，因为KF依赖于膝关节的前屈速度(KFV)。我们以踝关节垂直加速度峰值作为基于运动学的间接测量推离的指标，并研究了它与KF和KFV的关系。20名健康受试者以快速步行(v=95+/-5%身高S(-1))，以自选速度(v=74+/-5%身高S(-1))，慢(v=54+/-6%身高S(-1))和非常慢(v=38+/-5%身高S(-1))和52例卒中合并SKG患者(年龄60+/-11岁，v=20+/-11%身高S(-1))。0.001)和髋关节屈曲加速(p<；0.001)。KF看起来像是一种由脚踝推离驱动的自下而上的机构。经回归分析，PMVA-KFV因果关系呈严格线性关系，R-2=0.967，KFV=0+7.1xPMVA，P<；0.0001。对于44/52例患者，KFV减少合并缺乏推出。来自8/52名患者的数据仅在模型的95%可信区间之外，因此需要刹车机制来解释KFV的减少。在我们样本的成人中风患者中，推离损伤(85%的病例)而不是大腿肌肉产生的不适当的膝关节伸展力矩是SKG的主要原因。这一结果可以解释低平均疗效(
Stiff-knee gait (SKG) is a common abnormal gait pattern in patients after stroke characterized by insufficient knee flexion (KF) during swing. Overactivity of the rectus femoris (RF) is considered the primary cause of SKG. Inadequate push-off has been indicated as an additional cause in the recent literature, as KF depends on knee flexion velocity in preswing (KFV).We used the peak of vertical acceleration of the malleolus (PMVA) as a kinematic-based indirect measure of push-off and studied its relationship with KF and KFV in a sample of 20 healthy subjects walking fast (v = 95 +/- 5% height s(-1)), at self-selected speed (v = 74 +/- 5% height s(-1)), slow (v = 54 +/- 6% height s(-1)) and very slow (v = 38 +/- 5% height s(-1)) and in a sample of 52 stroke patients with SKG (age 60 +/- 11, v = 20 +/- 11% height s(-1)).In healthy subjects PMVA occurred before knee flexion acceleration (p < 0.001) and hip flexion acceleration (p < 0.001). KF appeared as a bottom-up mechanism driven by the ankle push-off. From a regression analysis, the PMVA-KFV cause-effect relationship resulted strictly linear, with R-2 = 0.967, KFV = 0 + 7.1 x PMVA, P < 0.0001.Data from SKG patients were compared to this normal cause-effect model. For 44/52 patients the reduced KFV was combined with lack of push-off. Data from 8/52 patients only were statistically outside the 95% CI of the model, thus requiring for a braking mechanism to explain KFV reduction.In stroke adults of our sample the push-off impairment (85% of cases) and not the inappropriate knee extension moment produced by the thigh muscles was the primary cause of SKG. This result could explain the low average efficacy (