中风后行走速度、经济性和稳定性之间的相互作用

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Neurologic Physical Therapy Pub Date : 2023-04-01 Epub Date: 2023-03-02 DOI:10.1097/NPT.0000000000000431
Louis N Awad, Brian A Knarr, Pawel Kudzia, Thomas S Buchanan
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引用次数: 0

摘要

背景和目的:能量最小化被认为是自然选择的首选步行速度的基础;然而,中风后患者的步行速度低于其最经济的速度,这可能是为了优化其他目标,如稳定性。本研究的目的是考察步行速度、经济性和稳定性之间的相互作用:方法:七名慢性偏瘫患者在跑步机上以三种随机速度中的一种行走:慢速、优先速度和快速。同时测量速度引起的行走经济性(即移动 1 kg 体重 1 ml O 2 /kg/m 所需的能量)和稳定性的变化。稳定性被量化为行走过程中骨盆质心(pCoM)内外侧运动的规律性和发散性,以及骨盆质心相对于支撑基点的运动:较慢的步行速度更稳定(即骨盆质量中心运动的规律性增加 10% ± 5%,发散性减少 26% ± 16%),但经济性降低 12% ± 5%。相反,行走速度较快的人经济性提高了 9% ± 8%,但稳定性也较差(即 pCoM 运动的不规则性提高了 17% ± 5%)。步行速度较慢的人在步行速度较快时能量效益更高(rs = 0.96,P < 0.001)。神经运动障碍较严重的人在步行速度较慢时,稳定性益处增强(rs = 0.86,P = 0.01):讨论与结论:中风后患者似乎更喜欢快于其最稳定速度但慢于其最经济速度的行走速度。中风后的首选步行速度似乎兼顾了稳定性和经济性。为了鼓励更快、更经济的行走,可能需要解决pCoM内外侧运动的稳定控制缺陷。视频摘要可获得作者的更多见解(见视频,补充数字内容1,http://links.lww.com/JNPT/A416 )。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Interplay Between Walking Speed, Economy, and Stability After Stroke.

Background and purpose: Energy minimization is thought to underlie the naturally selected, preferred walking speed; however, people post-stroke walk slower than their most economical speed, presumably to optimize other objectives, such as stability. The purpose of this study was to examine the interplay between walking speed, economy, and stability.

Methods: Seven individuals with chronic hemiparesis walked on a treadmill at 1 of 3 randomized speeds: slow, preferred, and fast. Concurrent measurements of speed-induced changes in walking economy (ie, the energy needed to move 1 kg of bodyweight 1 ml O 2 /kg/m) and stability were made. Stability was quantified as the regularity and divergence of the mediolateral motion of the pelvic center of mass (pCoM) during walking, as well as pCoM motion relative to the base of support.

Results: Slower walking speeds were more stable (ie, pCoM motion was 10% ± 5% more regular and 26% ± 16% less divergent) but 12% ± 5% less economical. Conversely, faster walking speeds were 9% ± 8% more economical, but also less stable (ie, pCoM motion was 17% ± 5% more irregular). Individuals with slower walking speeds had an enhanced energetic benefit when walking faster ( rs = 0.96, P < 0.001). Individuals with greater neuromotor impairment had an enhanced stability benefit when walking slower ( rs = 0.86, P = 0.01).

Discussion and conclusions: People post-stroke appear to prefer walking speeds that are faster than their most stable speed but slower than their most economical speed. The preferred walking speed after stroke appears to balance stability and economy. To encourage faster and more economical walking, deficits in the stable control of the mediolateral motion of the pCoM may need to be addressed.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A416 ).

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来源期刊
Journal of Neurologic Physical Therapy
Journal of Neurologic Physical Therapy CLINICAL NEUROLOGY-REHABILITATION
CiteScore
5.70
自引率
2.60%
发文量
63
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.
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