Effect of pedaling exercise on the hemiplegic lower limb.

蹬踏，其往复运动的肌肉活动模式类似于步态，可能有助于偏瘫中风患者的肌肉再训练。为验证其促进下肢肌选择性激活的有效性并阐明其神经生理学机制，我们进行了以下实验：1）研究了17例慢性脑卒中偏瘫患者以5 N-m蹬踏5 min后下肢肌活动的变化。在padaling，我们观察到肌肉活动在受影响的肢体是反相的对侧。与膝关节主动伸展时相比，股四头肌和胫骨前肌的活动显著增加。结果表明，蹬踏能促进重度偏瘫患者的时相性和协调性肌肉活动。 关于我们 在步态和痉挛状态下蹬踏，记录6例脑卒中患者步行时比目鱼肌的最大H/M值。蹬踏后，H/M下降，股四头肌活动增加，在立场阶段的影响。3）在健康受试者中，研究了改变蹬踏姿势、速度、最大伸膝角度和听觉提示对肌肉活动的影响。4）在上述研究结果的基础上，我们开始了一项随机对照试验，以测试踩踏板在偏瘫脑卒中中的有效性。干预组（I）以5 N-m的速度进行7 min的蹬踏，5 d/周，共4周;对照组（C）进行膝关节的随意伸展和屈曲。结果测量包括比目鱼肌H/M、步态参数和步态期间的肌肉活动。目前，I组入组5例患者，C组入组4例患者。少

Pedaling, whose reciprocating muscle activity pattern is similar to gait, could be useful for muscle retraining in patients with hemiparetic stroke. With the objectives of testing its effectiveness to facilitate selective activation in paretic lower extremity muscles and clarifying its neurophysiological mechanisms, we performed the following experiments.1)We studied changes of muscle activities after 5-min of pedaling at 5 N-m in 17 nonambulatory patients with chronic hemiparetic stroke. During padaling, we observed muscle activities in the affected limb that were antiphasic to the contralateral side. Quadriceps and tibialis anterior muscle activities increased significantly compared with those during voluntary knee extension effort. Their postpedaling facilitation and the inhibition of gastrocnemius lasted at least for 30 min. These findings suggested that pedaling could facilitate phasic and coordinated muscle activities in patients with severe hemiparesis.2)To assess the effects of … More pedaling on gait and spasticity, we obtained maximal H/M from soleus on the paretic side and recorded muscle activities during walking in 6 patients with stroke. After pedaling, the H/M decreased and quadriceps muscle activity increased on the affected side during the stance phase. These suggested that pedaling could inhibit spasticity and facilitate quadriceps.3)In healthy persons, we studied the effects of changing pedaling postures, speeds, maximal knee extension angles and auditory cuing on muscle activities. The results formed a useful basis for clinical application of pedaling.4)Based on the above results, we started a RCT to test the effectiveness of pedaling in hamiparetic stroke. The intervention group (I) performed 7-min of pedaling at 5 N-m, 5 days/week for 4 weeks, and the control group (C) performed voluntary knee extension and flexion. The outcome measures included soleus H/M, gait parameters and muscle activities during gait. Currently, 5 patients for I and 4 patients for C are enrolled. Less