Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group.
Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group.
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DOI：
10.3389/fspor.2023.1195773
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发表时间：
2023
影响因子：
2.7
通讯作者：
Kannan, Lakshmi
中科院分区：
文献类型：
--
作者：
Bhatt, Tanvi;Dusane, Shamali;Gangwani, Rachana;Wang, Shuaijie;Kannan, Lakshmi
基于扰动的训练已被证明在降低慢性中风(PWCS)患者跌倒风险方面有效。然而，大多数证据来自基于跑步机的站姿研究，缺乏专注于训练地面不安行走以及探索偏瘫和非偏瘫肢体的相对贡献的研究。因此，这项研究考察了双侧地面步态滑移扰动训练后，PWCS是否能够获得运动适应，并证明立即保留了抗跌倒技能。65个PWC被随机分配到训练组，在步行过程中接受8个非轻瘫(NP-S1至NP-S8)和轻瘫(P-S1至P-S8)地上滑块，然后是一个混合块(7个非轻瘫和轻瘫滑块，每个块夹杂着未受干扰的步行试验)(NP-S9/P-S9到NP-S15/P-S15)或(Ii)对照组，按随机顺序接受单个非轻瘫和轻瘫滑块。评估员和培训人员没有失明。训练组在休息30分钟后测试即刻保持能力。主要结果包括实验室诱发的滑倒结果(摔倒和失去平衡)和重心(COM)状态稳定。了解影响稳定性的运动学因素的次要结果包括恢复策略、肢体运动学、滑动运动学和恢复步长。从第一次试验到最后一次试验(S1vs.S8)，训练组中的PwCS显示出从第一次试验到最后一次试验(S1vs.S8)的跌倒次数减少(p <； 0.01)，滑倒后稳定性提高(p <； 0.01)。在混合块训练中，稳定性和滑动运动学没有进一步的改善(S9vs.S15)(p >； 0.01)。在第一次和最后一次训练试验(S1vs.S15)中，非偏瘫和偏瘫滑倒后的稳定性都有所改善，然而，滑倒前的稳定性只在非偏瘫滑倒时有所改善(p <； 0.01)。在保持试验中，训练组在非轻瘫和轻瘫滑倒方面的跌倒次数和滑倒后稳定性均高于对照组(p <； 0.01)。在固位试验中，两组偏瘫滑脱的稳定性均低于非轻瘫滑脱(p <； )。在双侧地面步态滑移扰动训练后，PWCS可以通过调整其滑脱后COM状态的稳定性来减少实验室诱发的滑倒和后向平衡丧失结果。这种反应性适应在训练后在PWCS中获得和保持得更好，尤其是在非偏瘫滑脱上，这表明对于轻瘫滑脱需要更大的剂量。NCT03205527
Perturbation-based training has shown to be effective in reducing fall-risk in people with chronic stroke (PwCS). However, most evidence comes from treadmill-based stance studies, with a lack of research focusing on training overground perturbed walking and exploring the relative contributions of the paretic and non-paretic limbs. This study thus examined whether PwCS could acquire motor adaptation and demonstrate immediate retention of fall-resisting skills following bilateral overground gait-slip perturbation training. 65 PwCS were randomly assigned to either (i) a training group, that received blocks of eight non-paretic (NP-S1 to NP-S8) and paretic (P-S1 to P-S8) overground slips during walking followed by a mixed block (seven non-paretic and paretic slips each interspersed with unperturbed walking trials) (NP-S9/P-S9 to NP-S15/P-S15) or (ii) a control group, that received a single non-paretic and paretic slip in random order. The assessor and training personnel were not blinded. Immediate retention was tested for the training group after a 30-minute rest break. Primary outcomes included laboratory-induced slip outcomes (falls and balance loss) and center of mass (CoM) state stability. Secondary outcomes to understand kinematic contributors to stability included recovery strategies, limb kinematics, slipping kinematics, and recovery stride length. PwCS within the training group showed reduced falls (p < 0.01) and improved post-slip stability (p < 0.01) from the first trial to the last trial of both paretic and non-paretic slip blocks (S1 vs. S8). During the mixed block training, there was no further improvement in stability and slipping kinematics (S9 vs. S15) (p > 0.01). On comparing the first and last training trial (S1 vs. S15), post-slip stability improved on both non-paretic and paretic slips, however, pre-slip stability improved only on the non-paretic slip (p < 0.01). On the retention trials, the training group had fewer falls and greater post-slip stability than the control group on both non-paretic and paretic slips (p < 0.01). Post-slip stability on the paretic slip was lower than that on the non-paretic slip for both groups on retention trials (p < 0.01). PwCS can reduce laboratory-induced slip falls and backward balance loss outcomes by adapting their post-slip CoM state stability after bilateral overground gait-slip perturbation training. Such reactive adaptations were better acquired and retained post-training in PwCS especially on the non-paretic slips than paretic slips, suggesting a need for higher dosage for paretic slips. NCT03205527
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影响因子：
2.4
作者：
Cham, R;Redfern, MS
通讯作者：
Redfern, MS
影响因子：
2.5
作者：
Dusane, Shamali;Bhatt, Tanvi
通讯作者：
Bhatt, Tanvi
影响因子：
2
作者：
Bhatt, T;Wening, JD;Pai, YC
通讯作者：
Pai, YC
影响因子：
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作者：
Dusane, Shamali;Bhatt, Tanvi
通讯作者：
Bhatt, Tanvi
密集的多平台躯干训练以及中风患者的平衡，流动性和跌倒风险的影响以及一项随机对照试验的影响。
DOI：
10.1177/03000605211059413
发表时间：
2021-11
期刊：
The Journal of international medical research
影响因子：
--
作者：
Ahmed U;Karimi H;Amir S;Ahmed A
通讯作者：
Ahmed A