Biomechanical gait characteristics of naturally occurring unsuccessful foot clearance during swing in individuals with chronic stroke
Biomechanical gait characteristics of naturally occurring unsuccessful foot clearance during swing in individuals with chronic stroke
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DOI：
10.1016/j.clinbiomech.2015.08.018
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发表时间：
2015-12-01
影响因子：
1.8
通讯作者：
Lewek, Michael D.
中科院分区：
文献类型：
--
作者：
Burpee, Jessica L.;Lewek, Michael D.
背景：中风后步态力学改变很常见，并可能增加福尔斯的风险。麻痹性步态障碍以前已经比较了非麻痹肢体或控制参与者。不幸的是，生物力学参数的基本情况下，自然发生的不成功的脚间隙（TRIPS）还没有被检查在个人与慢性stroke.Methods：步态数据从26名参与者与慢性中风获得双带仪表跑步机。确定了成功和不成功的脚摆动。时间，运动学和动力学的措施发生在后期的立场，脚趾关闭，摆动之间的行程和非行程步骤使用配对样本t检验的瘫痪肢体进行了比较。α = 0.004用于调整多重比较。结果：在麻痹肢体中，脚趾离开时的踝关节角度（P = 0.003; d = 0.64），脚趾离地时膝关节屈曲速度（P < 0.001; d = 0.73），站立末期的最大膝关节伸展力矩（P < 0.001; d = 0.74）在绊倒和非绊倒步骤之间有显著差异。在绊倒步骤中，足趾离地时踝跖屈增加1.0度，膝关节屈曲速度降低17.6度/秒，峰值膝关节伸展力矩增加0.011 Nm/kg。解释：在慢性中风患者中，似乎只需要轻微的麻痹肢体运动变化就可以导致绊倒。虽然很小，但在不成功的足部清理过程中发生在麻痹肢体中的多关节生物力学变化导致肢体功能更长。因此，可能需要针对麻痹肢体中的多个关节进行干预，以降低中风后绊倒的风险。(C)2015爱思唯尔有限公司版权所有。
Background: Altered gait mechanics are common following stroke and may increase the risk of falls. Paretic gait impairments have been previously compared to the non-paretic limb or control participants. Unfortunately, the biomechanical parameters underlying instances of naturally occurring unsuccessful foot clearance (trips) have yet to be examined in individuals with chronic stroke.Methods: Gait data from 26 participants with chronic stroke were obtained on a dual-belt instrumented treadmill. Instances of successful and unsuccessful foot swing were identified. Temporal, kinematic, and kinetic measures of the paretic limb occurring during late stance, toe-off, and swing were compared between trip and non-trip steps using paired samples t-tests. An alpha = 0.004 was used to adjust for multiple comparisons.Findings: In the paretic limb, the ankle angle at toe off (P = 0.003; d = 0.64), knee flexion velocity at toe off (P < 0.001; d = 0.73), and peak knee extension moment during terminal stance (P < 0.001; d = 0.74) were significantly different between trips and non-trip steps. During trip steps, ankle plantarflexion at toe-off was 1.0 degrees greater, knee flexion velocity was reduced by 17.6 degrees/sec, and peak knee extension moment was increased by 0.011 Nm/kg . m compared to non-trip steps.Interpretation: It appears to take only minor changes in the movement of the paretic limb to result in a trip in individuals with chronic stroke. Although small, the multi-joint biomechanical changes occurring in the paretic limb during unsuccessful foot clearance result in a functionally longer limb. Thus, interventions targeting multiple joints in the paretic limb may be needed to reduce the risk of trips following stroke. (C) 2015 Elsevier Ltd. All rights reserved.