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Improving Spatiotemporal Gait Asymmetry Has Limited Functional Benefit for Individuals Poststroke
Journal of Neurologic Physical Therapy ( IF 2.6 ) Pub Date : 2020-07-01 , DOI: 10.1097/npt.0000000000000321
Hannah P. Ryan , Carty Husted , Michael D. Lewek

Supplemental Digital Content is Available in the Text. Background and Purpose: Prior literature suggests a relationship between spatiotemporal gait asymmetry and metabolic cost of walking, balance, endurance, quality of life, and physical activity in people with chronic stroke. Our purpose was to determine whether targeting spatiotemporal gait symmetry would concomitantly improve these measures. Methods: This study represents secondary outcome measures from a trial in which 48 participants with chronic stroke were randomized to groups that all targeted spatiotemporal gait asymmetry. Measures of balance, daily step count, endurance (6-minute walk test [6MWT), metabolic cost of walking, quality of life (Stroke Impact Scale [SIS]), and overground spatiotemporal asymmetries were collected 1 week prior to and following training. Separate analyses were performed for those who trained for spatial versus temporal asymmetry. The effect of time (pre/post) was examined for all measures and correlational analyses evaluated the potential relationships between changes in spatiotemporal asymmetry and all other measures. Results: Individuals who trained to target step length asymmetry improved balance, 6MWT distance, metabolic cost of walking, and SIS-Mobility. Individuals who trained to target stance time asymmetry improved balance, 6MWT distance, SIS-Mobility, and SIS-Global recovery scores. However, step length asymmetry improvements were only related to improved 6MWT distance (P = 0.025; r = −0.49). Stance time asymmetry improvements were only related to improved metabolic cost of walking (P = 0.031; r = 0.558). Discussion and Conclusions: Despite a targeted training approach and noted improvements in most measures, these changes did not appear to arise from improved spatiotemporal gait asymmetry. Furthermore, improvements in gait function observed in the laboratory setting did not appear to translate to increased community mobility. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A316).

中文翻译:

改善时空步态不对称对中风后个体的功能益处有限

补充数字内容在文本中可用。背景和目的:先前的文献表明,慢性中风患者的时空步态不对称与步行代谢成本、平衡、耐力、生活质量和身体活动之间存在关系。我们的目的是确定针对时空步态对称性是否会同时改进这些措施。方法:本研究代表了一项试验的次要结果测量,其中 48 名慢性卒中参与者被随机分配到所有针对时空步态不对称的组。在训练前后 1 周收集平衡、每日步数、耐力(6 分钟步行测试 [6MWT)、步行的代谢成本、生活质量(中风影响量表 [SIS])和地面时空不对称的测量。对那些接受过空间与时间不对称训练的人进行了单独的分析。检查所有措施的时间(前/后)的影响,相关性分析评估了时空不对称变化与所有其他措施之间的潜在关系。结果:针对步长不对称进行训练的个体改善了平衡、6MWT 距离、步行的代谢成本和 SIS-Mobility。训练目标站立时间不对称的个体改善了平衡、6MWT 距离、SIS 机动性和 SIS 全局恢复分数。然而,步长不对称的改善仅与 6MWT 距离的改善有关(P = 0.025;r = -0.49)。站立时间不对称的改善仅与步行代谢成本的改善有关(P = 0.031;r = 0.558)。讨论和结论:尽管有针对性的训练方法并注意到大多数措施的改进,但这些变化似乎并不是由改进的时空步态不对称引起的。此外,在实验室环境中观察到的步态功能的改善似乎并未转化为社区流动性的增加。视频摘要可提供作者的更多见解(参见视频,补充数字内容 1,可在:http://links.lww.com/JNPT/A316 获得)。
更新日期:2020-07-01
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