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脑瘫患儿跨过障碍物时的步态 : 通过运动学分析对动态平衡和躯干控制的横断型研究

  2016-10-10

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【文献标题】脑瘫患儿跨过障碍物时的步态 : 通过运动学分析对动态平衡和躯干控制的横断型研究(Obstacle Crossing During Gait in Children With Cerebral Palsy: Cross-Sectional Study With Kinematic Analysis of Dynamic Balance and Trunk Control)

【文献来源】Phys Ther. 2016 Aug;96(8):1208-15. doi: 10.2522/ptj.20150360. 

【文献摘要】

目的 研究的目的是对比脑瘫患儿和一般发展儿童在跨越障碍物时的躯干和下肢动力学及全身质量中心控制。

设计 研究为横断面研究,三十四名5-17岁的儿童(17名脑瘫患儿和17名一般发展儿童)进行年龄与身高的匹配后,完成了跨越10厘米障碍物的两次步态试验。


方法 通过多用途3维动作追踪系统和测力板获取了三维运动学和动力学数据。躯干数据使用经过验证的模型来获得。

结果 所有儿童跨越障碍物时有着相似的髋关节和膝关节动力学,步长和单脚支撑时长。对于脑瘫患儿,步宽增加了4.81厘米,且质心移动速度在主导肢体脚尖离地(0.31 m/s)和主导肢体跨越(0.2 m/s)时显著较慢。脑瘫患儿显示出异常的躯干及盆骨运动,特征为盆骨倾斜度明显更大,盆骨倾斜,以及任务过程中躯干转动,主导肢体跨越时侧向躯体倾斜度增加(3.7°),后侧肢体跨越时矢状面躯干动作更大(5.1°)

局限性 研究不足以分析双侧瘫痪和偏瘫儿童之间的区别。

结论 脑瘫患儿需要更多的躯干和盆骨矫正以成功跨越障碍物。躯干活动增加可能是对于远端稳定性减少的补偿或是反应较差的近端控制的主要问题。这些发现表明康复需要集中于近端躯干控制和远端稳定性以改善平衡。


Background Balance problems are common in children who have cerebral palsy (CP) but are active and ambulant. Control of the whole-body center of mass is critical in maintaining dynamic stability during challenging mobility tasks, such as clearing an obstacle while walking.



Objective The objective of this study was to compare trunk and lower limb kinematics and center-of-mass control in children with CP and those in children with typical development during obstacle crossing.


Design This was a cross-sectional study. Thirty-four children who were 5 to 17 years of age (17 with CP and 17 with typical development) and matched in age and height completed 2 gait trials involving crossing a 10-cm obstacle.


Methods Three-dimensional kinematic and kinetic data were captured with a general-purpose 3-dimensional motion tracking system and forceplates. Trunk data were captured with a validated model.


Results All children cleared the obstacle with similar hip and knee kinematics, step length, and single-support duration. In children with CP, step width was increased by 4.81 cm, and center-of-mass velocity was significantly slower at lead limb toe-off (0.31 m/s) and during lead limb clearance (0.2 m/s). Children with CP showed altered trunk and pelvis movement, characterized by significantly greater pelvic obliquity, pelvic tilt, and trunk rotation throughout the task, increased lateral trunk lean during lead limb crossing (3.7°), and greater sagittal trunk movement as the trail limb crossed (5.1°).


Limitations The study was not powered to analyze differences between children with diplegia and those with hemiplegia.


Conclusions Children with CP required greater adjustments at the trunk and pelvis to achieve successful obstacle crossing. The increase in trunk movement could have been compensatory for reduced stability distally or for a primary problem reflecting poor proximal control. The findings suggest that rehabilitation should focus on both proximal trunk control and distal stability to improve balance.


原文链接:http://ptjournal.apta.org/content/96/8/1208.long


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