Dynamic instability during obstacle crossing following traumatic brain injury
Dynamic instability during obstacle crossing following traumatic brain injury
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DOI：
10.1016/j.gaitpost.2003.09.007
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发表时间：
2004-12-01
期刊：
影响因子：
2.4
通讯作者：
Basford, JR
中科院分区：
文献类型：
--
作者：
Chou, LS;Kaufman, KR;Basford, JR
尽管临床检查显示步态正常，但创伤性脑损伤(TBI)患者仍抱怨行走时“不平衡”或“不稳”。因此，这项研究的目的是确定是否有可能对脑外伤后没有明显神经肌肉起源的动态稳定性进行定量评估。10名记录在案的脑外伤患者和10名年龄、性别和身高匹配的健康人参与了这项研究。所有受试者都被指示进行无障碍的水平行走，并跨过对应于他们身高的2.5%、5%、10%和15%的障碍物。采用13连杆人体生物力学模型计算了人体整体质心的运动学。与对照组相比，脑外伤患者的步速明显减慢，步幅明显缩短。此外，与对照组相比，颅脑损伤患者的大脑中外侧(M-L)运动显著增大且速度明显加快，其COM与压力中心(COP)之间的M-L分离距离(M-L)显著增大。这些测量表明，患有脑外伤的受试者难以维持额面的动态稳定性，并且成功阻止其矢状面动量的能力降低。这些发现提供了一种客观的测量方法，反映了在临床检查中无法观察到的对遭受脑外伤的个体的不稳定抱怨。这种识别创伤性脑损伤后可能影响患者安全的功能损伤的能力对于预防恢复期的再次损伤至关重要。(C)2003爱思唯尔B.V.保留所有权利。
Patients with traumatic brain injury (TBI) complain of "imbalance" or "unsteadiness" while walking, despite a normal gait on clinical examination. Thus, the purpose of this study was to determine if it was possible to quantitatively assess dynamic stability that did not have an obvious neuromuscular origin in individuals following TBI. Ten patients with documented TBI and 10 age, gender, and stature-matched healthy individuals participated in the study. All subjects were instructed to perform unobstructed level walking and to step over obstacles corresponding to 2.5%, 5%, 10%, and 15% of their height. A 13-link biomechanical model of the human body was used to compute the kinematics of the whole body center of mass (COM). Subjects with TBI walked with a significantly slower gait speed and shorter stride length than their matched controls. Furthermore, subjects with TBI displayed a significantly greater and faster medio-lateral (M-L) COM motion and maintained a significantly greater M-L separation distance between their COM and center of pressure (COP) than their matched control subjects. These measurements indicate that subjects with TBI have difficulty maintaining dynamic stability in the frontal plane and have a reduced ability to successfully arrest their sagittal momentum. These findings provide an objective measurement that reflects the complaints of instability not observable on clinical examination for individuals who have suffered a TBI. This ability to identify any functional impairment after a traumatic brain injury that may affect patient safety is critical for prevention of re-injury during the recovery period. (C) 2003 Elsevier B.V. All rights reserved.