Walking in an Unstable Environment: Strategies Used by Transtibial Amputees to Prevent Falling During Gait
Walking in an Unstable Environment: Strategies Used by Transtibial Amputees to Prevent Falling During Gait
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DOI：
10.1016/j.apmr.2013.07.020
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发表时间：
2013-11-01
影响因子：
4.3
通讯作者：
Houdijk, Han
中科院分区：
文献类型：
--
作者：
Hak, Laura;van Dieen, Jaap H.;Houdijk, Han
目的：研究小腿截肢者使用哪些策略来应对步态稳定性和步态适应性的挑战，以及这些策略与健全对照组使用的策略有何不同。设计：横断面研究。设置：安装在 6 自由度运动平台上的仪器跑步机与虚拟环境相结合。参与者：小腿截肢者 (n=10) 和健全对照者 (n=9)。 干预措施：步行表面的内侧 (ML) 平移用于控制步态稳定性。为了激发适应性步态模式，使用了一项步态适应性任务，其中受试者必须用膝盖引导的标记击中虚拟目标。主要结果指标：步行速度、步长、步频、步宽和选定的步态稳定性指标（短期 Lyapunov 指数以及向后和 ML 稳定裕度 [MoS]）。结果：截肢者比健全人走得更慢，步频更低，步幅更宽。这导致截肢者的 ML MoS 较大，但后向 MoS 较小。为了应对平衡扰动，两组都减少了步长，增加了步频和步宽。步行速度并没有因扰动而发生显着变化。这些适应导致了 ML 和落后 MoS 的增加。为了执行步态适应性任务，两组都减少了步长并增加了步宽，但没有改变步频和步行速度。两组均保持了 ML 和后向 MoS。结论：小腿截肢者有能力使用相同的策略来应对步态稳定性和适应性的挑战，程度与健全人相同。 (C) 2013 年美国康复医学会
Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls.Design: Cross-sectional study.Setting: An instrumented treadmill mounted onto a 6 degrees-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9).Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees.Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]).Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups.Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. (C) 2013 by the American Congress of Rehabilitation Medicine