Dynamic balance during walking adaptability tasks in individuals post-stroke.
Dynamic balance during walking adaptability tasks in individuals post-stroke.
复制标题
中风后个体步行适应性任务期间的动态平衡。
DOI：
10.1016/j.jbiomech.2018.04.029
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发表时间：
2018
影响因子：
2.4
通讯作者：
Fox,EmilyJ
中科院分区：
文献类型：
--
作者：
Vistamehr,Arian;Balasubramanian,ChitralakshmiK;Clark,DavidJ;Neptune,RichardR;Fox,EmilyJ
在社区活动中保持动态平衡是脑卒中后的主要挑战。社区步行既需要具备稳态水平的步行能力，也需要具备步行适应性。以往对脑卒中后平衡控制的研究主要集中在稳态步行方面，而对步行适应性任务的研究较少。本研究的目的是量化和比较中风后和健康成人在常见步行适应性任务中的动态平衡需求，并确定用于维持动态平衡的潜在机制的差异。我们收集了15名中风后偏瘫患者在稳定状态下向前和向后行走、过障和上坡时的运动学数据。此外，10名健康成人的数据为比较提供了基础。动态平衡是通过在步态周期的轻瘫、非轻瘫和健康对照的单腿站立阶段的每个解剖平面的全身角动量峰至峰范围来量化的。为了了解维持动态平衡的一些关键潜在机制的差异，研究了足部放置和跖屈肌激活。中风后的个体在大多数任务中都有明显的额叶动态平衡缺陷，特别是在父母单腿站立时。额平面平衡缺陷与更宽的双亲足放置、身体重心升高和较低的比目鱼肌活动有关。此外，越障任务对平衡性要求更高，尤其是在拖腿单站时。因此，改善跛足位置和踝关节跖屈肌活动，特别是在过障时，可能是卒中后社区活动中增强动态平衡的重要康复目标。
Maintaining dynamic balance during community ambulation is a major challenge post-stroke. Community ambulation requires performance of steady-state level walking as well as tasks that require walking adaptability. Prior studies on balance control post-stroke have mainly focused on steady-state walking, but walking adaptability tasks have received little attention. The purpose of this study was to quantify and compare dynamic balance requirements during common walking adaptability tasks post-stroke and in healthy adults and identify differences in underlying mechanisms used for maintaining dynamic balance. Kinematic data were collected from fifteen individuals with post-stroke hemiparesis during steady-state forward and backward walking, obstacle negotiation, and step-up tasks. In addition, data from ten healthy adults provided the basis for comparison. Dynamic balance was quantified using the peak-to-peak range of whole-body angular-momentum in each anatomical plane during the paretic, nonparetic and healthy control single-leg-stance phase of the gait cycle. To understand differences in some of the key underlying mechanisms for maintaining dynamic balance, foot placement and plantarflexor muscle activation were examined. Individuals post-stroke had significant dynamic balance deficits in the frontal plane across most tasks, particularly during the paretic single-leg-stance. Frontal plane balance deficits were associated with wider paretic foot placement, elevated body center-of-mass, and lower soleus activity. Further, the obstacle negotiation task imposed a higher balance requirement, particularly during the trailing leg single-stance. Thus, improving paretic foot placement and ankle plantarflexor activity, particularly during obstacle negotiation, may be important rehabilitation targets to enhance dynamic balance during post-stroke community ambulation.