双任务步行对缺血性卒中患者步态参数影响的研究

doi:10.3969/j.issn.1673-5765.2021.10.005

摘要/Abstract

摘要： 目的探讨双任务步行（dual-task walking，DTW）对缺血性卒中患者步态参数的影响。方法前瞻性入组2020年6月-2021年3月于首都医科大学附属北京天坛医院康复科住院的缺血性卒中患者。选择时钟任务作为DTW中的认知任务，受试者依次完成单任务步行（single-task walking， STW）和DTW。使用Codamotion三维动作捕捉系统采集患者执行任务时步态的运动学参数（膝关节、踝关节活动范围、最大屈膝角度、最大伸膝角度、最大踝背屈角度、最大踝跖屈角度）和时空参数（步速、跨步长、跨步时间、跨步速度、步长、步长时间、步频、支撑期百分比），计算时空参数的变异系数。比较患者进行STW和DTW时上述步态参数的差异。结果本研究共纳入28例缺血性卒中患者，男性20例（71.4%）。患者进行STW和DTW时步态的运动学参数差异无统计学意义。在时空参数方面，与STW时相比，进行DTW时患者的步速降低（0.69±0.23 m/s vs 0.80±0.27 m/s，P＜0.001）、步长（0.41±0.11 m vs 0.46±0.12 m，P＜0.001）和跨步长缩短（0.85±0.20 m vs 0.95±0.22 m，P＜0.001）。在时空参数变异性方面，与STW比较，卒中患者进行DTW时步长时间变异性[4.47（2.98～7.34）vs 2.58（1.76～4.27），P＝0.013]及步频变异性[4.59 （2.78～7.78）vs 2.71（1.84～4.44），P＝0.020]增加。结论卒中患者在进行DTW时更容易发现步态问题。与STW相比，双任务条件下的步态评估可能是更有效的卒中康复评估指标，也更适用于卒中后康复训练计划。

文章导读： DTW与STW相比要占用更多的大脑资源，因此更易反映缺血性卒中患者步态的异常，可能是更好地反映卒中患者功能恢复、评估治疗效果的指标。

关键词: 双任务步行; 卒中; 步态; 运动学参数; 时空参数

Abstract: Objective To explore the effects of dual-task walking (DTW) on gait parameters in patients with ischemic stroke. Methods The patients with ischemic stroke admitted in Department of Rehabilitation of Beijing Tiantan Hospital, Capital Medical University from June 2020 to March 2021 were prospectively enrolled in this study. The clock task was used as the cognitive task of DTW. All the subjects received single-task walking (STW) and DTW. The Codamotion 3D motion capture system was used to collect the kinematic parameters of gait (including the motion range of knee and ankle, the maximal angle of knee flexion and extension, the maximal angle of ankle dorsiflexion and plantar flexion) and spatiotemporal parameters (gait speed, stride length, stride time, stride speed, step length, step time, cadence and the percentage of supporting period), and the variability of

spatiotemporal parameters were calculated. The above gait parameters were compared during STW

and DTW. Results A total of 28 patients were included, with 20 males (71.4%). There were no statistical differences in kinematic parameters of gait in STW and DTW for all the patients. For spatiotemporal parameters, compared with STW, the patients during DTW had lower gait speed (0.69±0.23 m/s vs 0.80±0.27 m/s, P <0.001), shorter step length (0.41±0.11 m vs 0.46±0.12 m, P <0.001) and stride length (0.85±0.20 m vs 0.95±0.22 m, P <0.001), while the variability of step time [4.47 (2.98-7.34) vs 2.58 (1.76-4.27), P =0.013] and cadence [4.59 (2.78-7.78) vs 2.71 (1.84-4.44), P =0.020] were increased in stroke patients during DTW. Conclusions Stroke patients were more likely to have gait problems during DTW. Compared with STW, the gait assessment under the dual task walking may be a more effective indicator of stroke rehabilitation and is more suitable for application in post-stroke rehabilitation plan.

Key words: Dual-task walking; Stroke; Gait; Kinematic parameter; Spatiotemporal parameter

赵依双, 公维军, 范小伟, 张玉梅. 双任务步行对缺血性卒中患者步态参数影响的研究[J]. 中国卒中杂志, 2021, 16(10): 1006-1010.

ZHAO Yi-Shuang, GONG Wei-Jun, FAN Xiao-Wei, ZHANG Yu-Mei. Effects of Dual-Task Walking on Gait Parameters in Patients with Ischemic Stroke[J]. Chinese Journal of Stroke, 2021, 16(10): 1006-1010.

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