重视临床步态评估

doi:10.3969/j.issn.1673-5765.2020.01.017

摘要/Abstract

摘要：

步态是重要的行为学指标，步态异常是多种疾病、不同系统受累的共同表现。步态可通过定性、半定量和定量方法评估，其中定量的步态分析可客观、敏感地测量步态动力学、运动学特点，提供步态时空相关参数，评价步态的节律性、稳定性等多种特征。步态的多种特征，以及常速、快速、任务负荷等不同情景，为步态在流行病学、疾病鉴别、疾病机制等方面的研究提供了重要的观察角度。老年人的步态障碍，不仅可能与认知障碍共存，而且与生活质量下降、死亡风险增高、跌倒外伤等意外事件增加有关，给日渐老龄化的社会增加一定负担，需引起重视。随着生物物理与计算机专业发展，分析手段的先进化和标准化，步态与认知、神经影像、人工智能的结合，使步态分析具有较大的研究前景。

文章导读： 步态的异常反映人体多系统、多器官的病变，与认知障碍具有明显的相关性，对其进行定性和定量检查有利于发现早期病变，改善老年人的生活质量。

关键词: 步态; 步态异常; 老年

Abstract:

Gait is an important behavioral indicator, and abnormal gait is a common manifestation of a variety of diseases with different physiological systems involved. Gait evaluation includes qualitative, semi-quantitative and quantitative assessment methods. Quantitative gait analysis, which objectively and sensitively measures gait dynamics and kinematics, yields spatial and temporal parameters and describes gait related features such as rhythm and stability. The diverse characteristics of gait under diverse conditions (usual and fast walk, and dual tasks) provide important perspectives of gait in epidemiological research, disease diagnosis, and mechanism exploration. Gait dysfunction may coexist with cognitive impairment, and also may be associated with the declined quality of life and survival rate, and an increased risk of falls and injuries and other accidents in the elderly, which adds a certain burden to the aging society. With the development of biophysics and computer science, and the advanced evolution and standardization of analytical methods, the combination of gait with cognition, neuroimaging and artificial intelligence will bring greater research prospects for gait analysis.

Key words: Gait; Gait dysfunction; Elderly

陈慧敏，王伊龙. 重视临床步态评估[J]. 中国卒中杂志, 2020, 15(01): 102-107.

CHEN Hui-Min, WANG Yi-Long. Review on Gait Analysis[J]. Chinese Journal of Stroke, 2020, 15(01): 102-107.

参考文献

[1] FRITZ S，LUSARDI M. White paper："walking

speed：the sixth vital sign"[J]. J Geriatr Phys Ther，

2009，32（2）：46-49.

[2] PAHAPILL P A，LOZANO A M. The

pedunculopontine nucleus and Parkinson's disease[J].

Brain，2000，123（9）：1767-1783.

[3] SHIK M L，ORLOVSKY G N. Neurophysiology of

locomotor automatism[J]. Physiol Rev，1976，56（3）：

465-501.

[4] ARMSTRONG D M. The supraspinal control of

mammalian locomotion[J]. J Physiol，1988，405（1）：

1-37.

[5] JAHN K，DEUTSCHLANDER A，STEPHAN T，et

al. Supraspinal locomotor control in quadrupeds and

humans[J]. Prog Brain Res，2008，171（1）：353-362.

[6] VERLINDEN V J，VAN DER GEEST J N，

HEERINGA J，et al. Gait shows a sex-specific

pattern of associations with daily functioning in a

community-dwelling population of older people[J].

Gait Posture，2015，41（1）：119-124.

[7] LORD S，HOWE T，GREENLAND J，et al. Gait

variability in older adults：a structured review of

testing protocol and clinimetric properties[J]. Gait

Posture，2011，34（4）：443-450.

[8] CULLEN S，MONTERO-ODASSO M，BHERER L，

et al. Guidelines for gait assessments in the Canadian

Consortium on Neurodegeneration in Aging（CCNA）

[J]. Can Geriatr J，2018，21（2）：157-165.

[9] MUIR S W，GOPAUL K，MONTERO ODASSO

M M. The role of cognitive impairment in fall risk

among older adults：a systematic review and metaanalysis[

J]. Age Ageing，2012，41（3）：299-308.

[10] KUEPER J K，SPEECHLEY M，LINGUM N

R，et al. Motor function and incident dementia：a

systematic review and meta-analysis[J]. Age Ageing，

2017，46（5）：729-738.

[11] MARUSIC U，VERGHESE J，MAHONEY J R.

Cognitive-based interventions to improve mobility：

a systematic review and meta-analysis[J]. J Am Med

Dir Assoc，2018，19（6）：484-491.

[12] BURACCHIO T，DODGE H H，HOWIESON D，

et al. The trajectory of gait speed preceding mild

cognitive impairment[J]. Arch Neurol，2010，67（8）：

980-986.

[13] DOI T，SHIMADA H，MAKIZAKO H，et al.

Motoric cognitive risk syndrome：association with

incident dementia and disability[J]. J Alzheimers Dis，

2017，59（1）：77-84.

[14] DUMURGIER J，ARTAUD F，TOURAINE C，et al.

Gait speed and decline in gait speed as predictors of

incident dementia[J]. J Gerontol A Biol Sci Med Sci，

2017，72（5）：655-661.

[15] GRAY S L，ANDERSON M L，HUBBARD R A，

et al. Frailty and incident dementia[J]. J Gerontol A

Biol Sci Med Sci，2013，68（9）：1083-1090.

[16] WANG L，LARSON E B，BOWEN J D，et al.

Performance-based physical function and future

dementia in older people[J]. Arch Intern Med，2006，

166（10）：1115-1120.

[17] CAMARGO E C，WEINSTEIN G，BEISER A S，et

al. Association of physical function with clinical and

subclinical brain disease：the Framingham Offspring

Study[J]. J Alzheimers Dis，2016，53（4）：1597-

1608.

[18] MONTERO-ODASSO M M，BARNES B，

Speechley M，et al. Disentangling cognitive-frailty：

results from the Gait and Brain Study[J]. J Gerontol

A Biol Sci Med Sci，2016，71（11），1476-1482.

[19] VERGHESE J，WANG C，LIPTON R B，et al.

Quantitative gait dysfunction and risk of cognitive

decline and dementia[J]. J Neurol Neurosurg

Psychiatry，2007，78（9）：929-935.

[20] WELMER A K，RIZZUTO D，QIU C，et al.

Walking speed，processing speed，and dementia：a

population-based longitudinal study[J]. J Gerontol A

Biol Sci Med Sci，2014，69（12）：1503-1510.

[21] AMBONI M，COZZOLINO A，LONGO K，et al.

Freezing of gait and executive functions in patients

with Parkinson's disease[J]. Mov Disord，2008，23

（3）：395-400.

[22] TESSITORE A，AMBONI M，ESPOSITO F，et

al. Resting-state brain connectivity in patients

with Parkinson's disease and freezing of gait[J].

Parkinsonism Relat Disord，2012，18（6）：781-787.

[23] LI J，YUAN Y，WANG M，et al. Decreased

interhemispheric homotopic connectivity in

Parkinson's disease patients with freezing of gait：a

resting state fMRI study[J]. Parkinsonism Relat

Disord，2018，52（7）：30-36.

[24] LENKA A，NADUTHOTA R M，JHA M，et al.

Freezing of gait in Parkinson's disease is associated

with altered functional brain connectivity[J].

Parkinsonism Relat Disord，2016，24（3）：100-106.

[25] The LADIS Study Group，POGGESI A，PANTONI

L，INZITARI D，et al. 2001-2011：A decade of the

LADIS（Leukoaraiosis And DISability）Study：what

have we learned about white matter changes and

small-vessel disease?[J]. Cerebrovasc Dis，2011，32

（6）：577-588.

[26] SU N，LIANG X，ZHAI F F，et al. The consequence

of cerebral small vessel disease：linking brain

atrophy to motor impairment in the elderly[J]. Hum

Brain Mapp，2018，39（11）：4452-4461.

[27] STRINGHINI S，CARMELI C，JOKELA M，et

al. Socioeconomic status，non-communicable

disease risk factors，and walking speed in older

adults：multi-cohort population based study[J/OL].

BMJ，2018，360：k1046. https：//doi.org/10.1136/bmj.

k1046.

[28] NADKARNI N K，BOUDREAU R M，

STUDENSKI S A，et al. Slow gait，white matter

characteristics，and prior 10-year interleukin-6

levels in older adults[J]. Neurology，2016，87（19）：

1993-1999.

[29] BEAUCHET O，SEKHON H，BARDEN J，et al.

Association of motoric cognitive risk syndrome with

cardiovascular disease and risk factors：results from

an original study and meta-analysis[J]. J Alzheimers

Dis，2018，64（3）：875-887.

[30] WU T，HALLETT M，CHAN P. Motor automaticity

in Parkinson's disease[J]. Neurobiol Dis，2015，82

（10）：226-234.

[31] 陈慧敏，冯涛. 帕金森病步态异常的脑网络和神经

环路研究进展[J]. 中华神经科杂志，2017，50（3）：

238-240.

[32] STUDENSKI S，PERERA S，PATEL K，et al. Gait

speed and survival in older adults[J]. JAMA，2011，

305（1）：50-58.