Background

To assess the effects of the initial stepping limb on posterior fall recovery in individuals with chronic stroke, as well as to determine the benefits of fall-recovery training on these outcomes.

Methods

This was a single-group intervention study of 13 individuals with chronic stroke. Participants performed up to six training sessions, each including progressively challenging, treadmill-induced perturbations from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. The highest perturbation level achieved, the proportion of successful recoveries, step and trunk kinematics, as well as stance-limb muscle activation about the ankle were compared between the initial stepping limbs in the first session. Limb-specific outcomes were also compared between the first and last training sessions.

Findings

In the first session, initial steps with the non-paretic limb were associated with a higher proportion of success and larger perturbations than steps with the paretic limb (p = 0.02, Cohen's d = 0.8). Paretic-limb steps were wider relative to the center of mass (CoM; p = 0.01, d = 1.3), likely due to an initial standing position with the CoM closer to the non-paretic limb (p = 0.01, d = 1.4). In the last training session, participants recovered from a higher proportion of perturbations and advanced to larger perturbations (p < 0.05, d > 0.6). There were no notable changes in kinematic or electromyography variables with training (p > 0.07, d < 0.5).

Interpretation

The skill of posterior stepping in response to a perturbation can be improved with practice in those with chronic stroke, we were not able to identify consistent underlying kinematic mechanisms behind this adaptation.

中文翻译：

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适用于慢性中风患者的跌倒后恢复训练：单组干预研究

背景

评估初始踏步肢体对慢性中风患者后跌倒恢复的影响，并确定跌倒恢复训练对这些结果的益处。

方法

这是一项针对 13 名慢性中风患者的单组干预研究。参与者进行了多达六次训练，每次训练都包括站立时跑步机引起的渐进式挑战。进展集中于麻痹或非麻痹肢体的初始步骤。比较了第一阶段初始迈步肢体之间达到的最高扰动水平、成功恢复的比例、步伐和躯干运动学以及踝关节周围的站立肢体肌肉激活。还比较了第一次和最后一次训练之间的肢体特定结果。

发现

在第一阶段中，与麻痹肢体相比，非麻痹肢体的初始步骤与更高的成功率和更大的扰动相关（p  = 0.02，Cohen's d = 0.8）。麻痹肢体步幅相对于质心更宽（CoM；p  = 0.01，d = 1.3），可能是由于初始站立位置 CoM 更靠近非麻痹肢体（p = 0.01，d = 1.4） 。在最后一次训练中，参与者从较高比例的扰动中恢复并前进到较大的扰动（p  < 0.05，d > 0.6）。训练后运动学或肌电图变量没有显着变化（p  > 0.07，d < 0.5）。

解释

慢性中风患者的后步响应扰动的技能可以通过练习得到提高，但我们无法确定这种适应背后一致的潜在运动机制。