Symmetry Is Associated With Interlimb Coordination During Walking and Pedaling After Stroke.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurologic Physical Therapy Pub Date : 2022-04-01 DOI:10.1097/NPT.0000000000000377

Brice T Cleland, Sheila Schindler-Ivens

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引用次数: 4

Abstract

Background and purpose: Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.

Methods: Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsionwalk, %Workped) and interlimb phase coordination index (PCIwalk, PCIped) were computed. Clinical evaluations were the lower extremity Fugl-Meyer (FMLE) and walking speed. Associations were assessed with Spearman's rank correlations.

Results: Participants with stroke displayed asymmetry and impaired interlimb coordination compared with controls (P ≤ 0.001). There were significant correlations between asymmetry and impaired interlimb coordination (walking: R2 = 0.79, P < 0.001; pedaling: R2 = 0.62, P < 0.001) and between analogous measures across tasks (%Workped, %Propulsionwalk: R2 = 0.41, P = 0.01; PCIped, PCIwalk: R2 = 0.52, P = 0.003). Regardless of task, asymmetry and interlimb coordination were correlated with FMLE (R2 ≥ 0.48, P ≤ 0.004) but not walking speed. There was larger within group variation for %Propulsionwalk than %Workped (Z = 2.6, P = 0.005) and for PCIped than PCIwalk (Z = 3.6, P = 0.003).

Discussion and conclusions: Pedaling may provide useful insights about walking, and impaired interlimb coordination may contribute to asymmetry in walking. Pedaling and walking provide distinct insights into stroke-related impairments, related to whether the task allows compensation (walking > pedaling) or compels paretic limb use (pedaling > walking). Pedaling a device with a bisected crank shaft may have therapeutic value.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A365).

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对称性与中风后行走和蹬车时的肢间协调有关。

背景和目的:行走时的不对称可能是由肢体间协调性受损造成的。我们研究了这些关联:(1)行走时推进对称与肢间协调;(2)踩踏板时工作对称与肢间协调;(3)工作对称和肢间协调与临床损伤。方法:19例慢性脑卒中患者和15例对照者分别使用常规装置和带对分曲柄和上冲程辅助装置进行双侧下肢蹬踏。中风患者在分离带跑步机上行走。计算对称度量(%Propulsionwalk， %Workped)和肢间相位协调指数(PCIwalk, PCIped)。临床评价下肢Fugl-Meyer (FMLE)和步行速度。用Spearman秩相关法评估相关性。结果:与对照组相比，卒中患者表现出不对称性和肢体间协调受损(P≤0.001)。不对称与四肢间协调能力受损有显著相关性(行走:R2 = 0.79, P < 0.001;蹬车:R2 = 0.62, P < 0.001)和跨任务的类似测量之间(%Workped， %Propulsionwalk: R2 = 0.41, P = 0.01;PCIped、PCIwalk: R2 = 0.52, P = 0.003)。无论任务如何，不对称性和肢间协调性与FMLE相关(R2≥0.48,P≤0.004)，而与步行速度无关。Propulsionwalk组内变异大于Workped组(Z = 2.6, P = 0.005)， PCIped组内变异大于PCIwalk组(Z = 3.6, P = 0.003)。讨论和结论:踩踏板可能为行走提供有用的见解，而肢体间协调受损可能导致行走不对称。骑自行车和步行为中风相关损伤提供了独特的见解，涉及到这项任务是否允许补偿(步行>踩踏板)或强迫肢体麻痹(踩踏板>步行)。踩一种具有对分曲轴的装置可能具有治疗价值。视频摘要可以从作者那里获得更多的见解(参见视频，补充数字内容1，可在:http://links.lww.com/JNPT/A365)。

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来源期刊

Journal of Neurologic Physical Therapy CLINICAL NEUROLOGY-REHABILITATION

CiteScore

5.70

自引率

2.60%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Neurologic Physical Therapy (JNPT) is an indexed resource for dissemination of research-based evidence related to neurologic physical therapy intervention. High standards of quality are maintained through a rigorous, double-blinded, peer-review process and adherence to standards recommended by the International Committee of Medical Journal Editors. With an international editorial board made up of preeminent researchers and clinicians, JNPT publishes articles of global relevance for examination, evaluation, prognosis, intervention, and outcomes for individuals with movement deficits due to neurologic conditions. Through systematic reviews, research articles, case studies, and clinical perspectives, JNPT promotes the integration of evidence into theory, education, research, and practice of neurologic physical therapy, spanning the continuum from pathophysiology to societal participation.