Effect of pedaling exercise on the hemiplegic lower limb.

踏板的往复肌肉活动模式与步态相似，可用于偏瘫中风患者的肌肉再训练。为了测试其促进偏瘫下肢肌肉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）我们研究了 17 名不能行走的慢性偏瘫中风患者以 5 N-m 踩踏 5 分钟后肌肉活动的变化。在拍打过程中，我们观察到受影响肢体的肌肉活动与对侧相反。与自愿伸膝时相比，股四头肌和胫骨前肌的活动显着增加。他们的踩踏后促进和腓肠肌抑制至少持续 30 分钟。这些发现表明，踩踏可以促进严重偏瘫患者的阶段性和协调性肌肉活动。2）为了评估踩踏对步态和痉挛的影响，我们获得了偏瘫侧比目鱼肌的最大 H/M，并记录了 6 名中风患者行走期间的肌肉活动。踩踏后，在站立阶段，患侧的 H/M 降低，股四头肌活动增加。这些表明踩踏可以抑制痉挛并促进股四头肌。3）在健康人中，我们研究了改变踩踏姿势、速度、最大膝关节伸展角度和听觉提示对肌肉活动的影响。该结果为踩踏的临床应用奠定了有益的基础。4)基于上述结果，我们启动了一项RCT来测试踩踏治疗偏瘫中风的有效性。干预组 (I) 以 5 N-m 的速度踩踏 7 分钟，每周 5 天，持续 4 周，对照组 (C) 进行自愿膝关节伸展和屈曲。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，已入组 I 组 5 名患者和 C 组 4 名患者。较少的

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