社区不同跌倒风险老年人跨越障碍的步态运动学特征分析

doi:10.3969/j.issn.1006-9771.2020.01.020

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (1): 110-114.doi: 10.3969/j.issn.1006-9771.2020.01.020

社区不同跌倒风险老年人跨越障碍的步态运动学特征分析

孟站领¹,张庆来¹,刘昌亚²()

1.郑州大学体育学院,河南郑州市 450044
2.苏州大学体育学院,江苏苏州市 215000

收稿日期:2019-06-04 修回日期:2019-08-01 出版日期:2020-01-25 发布日期:2021-07-15
通讯作者: 刘昌亚 E-mail:liuchangya@suda.edu.cn
作者简介:孟站领(1975-),女,汉族,河北武邑县人,硕士,讲师,主要研究方向：运动与健康促进。|刘昌亚(1981-),男,江苏徐州市人,博士,主要研究方向：运动健身理论与实践。
基金资助:
教育部人文社会科学规划基金研究项目(19YJA890038)

Gait Characteristics in Old People with Various Risks of Falling as Obstacle Crossing in Community

MENG Zhan-ling¹,ZHANG Qing-lai¹,LIU Chang-ya²()

1. Physical Education College of Zhengzhou University, Zhengzhou, Henan 450044, China
2. Physical Education College of Soochow University, Suzhou, Jiangsu 215000, China

Received:2019-06-04 Revised:2019-08-01 Published:2020-01-25 Online:2021-07-15
Contact: LIU Chang-ya E-mail:liuchangya@suda.edu.cn
Supported by:
Ministry of Education Humanities and Social Sciences Planning Fund(19YJA890038)

摘要/Abstract

摘要：

目的探索社区不同跌倒风险老年人在跨越障碍过程中人体运动学参数特征。
方法 2016年7月至9月,采用计时起立-行走测试和五次坐立测试将27例社区老年人分为高跌倒风险组(H组,n = 15)和低跌倒风险组(L组, n = 12),应用美国APAS运动录像分析系统分析跨越障碍时的步态。
结果 H组跨越障碍总时间和跨越腿摆动时间长于L组(t > 2.073, P < 0.05);H组跨越障碍标准化最大质心高度小于L组( t = -2.014, P < 0.05)。位于障碍正上方时,H组两腿膝关节角度均大于L组( t > 2.106, P < 0.05),跨越腿髋关节位移速度小于L组( t = -2.119, P < 0.05);摆动腿踝关节的加速度低于L组( t = -3.038, P < 0.05)。
结论老年人跨越障碍时间延长、质心高度降低,跨越障碍过程中跨越腿髋关节移动速度和摆动腿踝关节加速度明显降低,均可增大跌倒风险。

关键词: 老年, 跌倒, 跨越障碍, 步态

Abstract:

Objective To explore the kinematics characteristics of obstacle crossing in old people with high or low falling risks in Community.
Methods From July to September, 2016, 27 old persons in community were divided into high falling risk group (H group, n = 15) and low fall risk group (L group, n = 12) according to the performance of Timed "Up and Go" Test and Five Times Sit to Stand Test. The kinematics characteristics were analyzed with Ariel Performance Analysis System as obstacle crossing.
Results The total time of crossing and the swing time of crossing legs were longer in H group than in L group (t > 2.073, P < 0.05), and the maximum height of standardized centre of mass was less in H group than in L group ( t = -2.014, P < 0.05). As the crossing leg was just above the obstacle, the angle of knee of crossing leg was more in H group than in L group ( t > 2.106, P < 0.05), the velocity of hip of crossing leg was less in H group than in L group ( t = -2.119, P < 0.05), and the acceleration of ankle of swinging leg was less in H group than in L group ( t = -3.038, P < 0.05).
Conclusion When the old people cross the obstacle, they trend to fall if they spend more time to overcome, lower in mass centre, in less speed of crossing hip and less acceleration of swinging ankle.

Key words: aged, fall, obstacle crossing, gait

中图分类号:

R592

孟站领,张庆来,刘昌亚. 社区不同跌倒风险老年人跨越障碍的步态运动学特征分析[J]. 《中国康复理论与实践》, 2020, 26(1): 110-114.

MENG Zhan-ling,ZHANG Qing-lai,LIU Chang-ya. Gait Characteristics in Old People with Various Risks of Falling as Obstacle Crossing in Community[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(1): 110-114.

图/表 6

表1

表2

表3

表4

表5

表6

参考文献 36

[1]	张庆来. 基于姿势控制能力的老年人跌倒风险评估研究[D]. 苏州:苏州大学, 2017.
[2]	张庆来, 张林. 老年人跌倒的研究进展[J]. 中国老年学杂志, 2016, 36(1):248-249.
[3]	中共中央国务院印发《"健康中国2030"规划纲要》[N]. 人民日报, 2016-10-26(001).
[4]	徐欣, 温子星. 人体动态稳定性控制理论在老年人防跌倒中的应用[J]. 中国康复理论与实践, 2017, 11(11):1254-1257.
[5]	张庆来. 姿势控制理论与老年人跌倒研究进展[J]. 首都体育学院学报, 2018, 30(6):569-576.
[6]	梁雷超, 吕娇娇, 黄灵燕, 等. 认知-姿势控制双任务在老年人跌倒研究中的应用进展[J]. 中国康复理论与实践, 2016, 22(11):1289-1293.
[7]	Nakano W, Fukaya T, Kanai Y, et al. Effects of temporal constraints on medio-lateral stability when negotiating obstacles[J]. Gait Posture, 2015, 42(2):158-164. doi: 10.1016/j.gaitpost.2015.05.004
[8]	房鹏飞, 张庆来. 可穿戴装置在老年跌倒防护中的应用现状[J]. 广州体育学院学报, 2017, 37(2):110-115.
[9]	Stegemöller E L, Buckley T A, Pitsikoulis C, et al. Postural instability and gait impairment during obstacle crossing in Parkinson's disease[J]. Arch Phys Med Rehabil, 2012, 93(4):703-709. doi: 10.1016/j.apmr.2011.11.004
[10]	张庆来, 张林. 老年人步态移动稳定性的增龄特征研究[J]. 中国运动医学杂志, 2017, 36(7):599-604.
[11]	梁雷超, 黄灵燕, 伍勰, 等. 膝骨关节炎对女性老年人步行动态稳定性的影响[J]. 体育科学, 2016, 36(3):61-66.
[12]	Draganich L F, Kuo C E. The effects of walking speed on obstacle crossing in healthy young and healthy older adults[J]. J Biomech, 2004, 37(6):889-896. pmid: 15111076
[13]	Licence S, Smith R, McGuigan M P, et al. Gait pattern alterations during walking, texting and walking and texting during cognitively distractive tasks while negotiating common pedestrian obstacles[J]. PLoS One, 2015, 10(7):e0133281. doi: 10.1371/journal.pone.0133281
[14]	Muir B C, Haddad J M, Heijnen M J H, et al. Proactive gait strategies to mitigate risk of obstacle contact are more prevalent with advancing age[J]. Gait Posture, 2015, 41(1):233-239. doi: 10.1016/j.gaitpost.2014.10.005 pmid: 25455212
[15]	Potocanac Z, Hoogkamer W, Carpes F P, et al. Response inhibition during avoidance of virtual obstacles while walking[J]. Gait Posture, 2014, 39(1):641-644. doi: 10.1016/j.gaitpost.2013.07.125 pmid: 23968973
[16]	Potocanac Z, Smulders E, Pijnappels M, et al. Response inhibition and avoidance of virtual obstacles during gait in healthy young and older adults[J]. Hum Movement Sci, 2015, 39:27-40. doi: 10.1016/j.humov.2014.08.015 pmid: 25461431
[17]	Caetano M J D, Lord S R, Brodie M A, et al. Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people[J]. Gait Posture, 2018, 59:188-192. doi: S0966-6362(17)30973-6 pmid: 29055270
[18]	Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test[J]. Phys Ther, 2000, 80(9):896-903. pmid: 10960937
[19]	Bohannon R W. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders[J]. Percept Motor Skill, 2006, 103(1):215-222. pmid: 17037663
[20]	Podsiadlo D, Richardson S. The timed 'Up & Go': A test of basic functional mobility for frail elderly persons[J]. J Am Geriatr Soc, 1991, 39(2):142-148. pmid: 1991946
[21]	陈岩, 孙威, 马腾, 等. 有跌倒史老年人跨越障碍步态特征的研究[J]. 山东体育学院学报, 2014, 30(5):62-64.
[22]	Bischoff H A, Stähelin H B, Monsch A U, et al. Identifying a cut‐off point for normal mobility: a comparison of the timed 'up and go' test in community‐dwelling and institutionalized elderly women[J]. Age Ageing, 2003, 32(3):315-320. pmid: 12720619
[23]	Pieruccini-Faria F, Jones J A, Almeida Q J. Motor planning in Parkinson's disease patients experiencing freezing of gait: the influence of cognitive load when approaching obstacles[J]. Brain Cogn, 2014, 87:76-85. doi: 10.1016/j.bandc.2014.03.005
[24]	Schulz B W. Healthy younger and older adults control foot placement to avoid small obstacles during gait primarily by modulating step width[J]. J Neuroeng Rehabil, 2012, 9(1):69. doi: 10.1186/1743-0003-9-69
[25]	Yiou E, Artico R, Teyssedre C A, et al. Anticipatory postural control of stability during gait initiation over obstacles of different height and distance made under reaction-time and self-initiated instructions[J]. Front Hum Neurosci, 2016, 10:449. doi: 10.3389/fpsyg.2019.00449
[26]	Murray M P, Kory R C, Clarkson B H. Walking patterns in healthy old men[J]. J Gerontol, 1969, 24(2):169-178. doi: 10.1093/geronj/24.2.169
[27]	Chen H C, Ashton-Miller J A, Alexander N B, et al. Stepping over obstacles: gait patterns of healthy young and old adults[J]. J Gerontol, 1991, 46(6):M196-M203. doi: 10.1093/geronj/46.6.M196
[28]	Saunders J B, Inman V T, Eberhart H D. The major determinants in normal and pathological gait[J]. J Bone Joint Surg Am, 1953, 35:543-558. doi: 10.2106/00004623-195335030-00003
[29]	Chou L S, Kaufman K R, Brey R H, et al. Motion of the whole body's center of mass when stepping over obstacles of different heights[J]. Gait Posture, 2001, 13(1):17-26. pmid: 11166550
[30]	Howcroft J, Kofman J, Lemaire E D, et al. Analysis of dual-task elderly gait in fallers and non-fallers using wearable sensors[J]. J Biomech, 2016, 49(7):992-1001. doi: 10.1016/j.jbiomech.2016.01.015
[31]	陈岩, 孙威, 杨帆, 等. 有跌倒史老年人在不同行走状态下足底压力特征研究[J]. 山东体育学院学报, 2014, 30(3):57-60.
[32]	Aboutorabi A, Arazpour M, Bahramizadeh M, et al. The effect of aging on gait parameters in able-bodied older subjects: a literature review[J]. Aging Clin Exp Res, 2016, 28(3):393-405. doi: 10.1007/s40520-015-0420-6 pmid: 26210370
[33]	Murat B, Hakan T. The evaluation of plantar pressure distribution in obese and non-obese adults[J]. Clin Biomech, 2004, 19:1055-1059. doi: 10.1016/j.clinbiomech.2004.07.008
[34]	Hortobagyi T, Rider P, Gruber A H, et al. Age and muscle strength mediate the age-related biomechanical plasticity of gait[J]. Eur J Appl Physiol, 2016, 116(4):805-814. doi: 10.1007/s00421-015-3312-8
[35]	Menz H B, Morris M E. Clinical determinants of plantar forces and pressures during walking in older people[J]. Gait Posture, 2006, 24:229-236. doi: 10.1016/j.gaitpost.2005.09.002
[36]	Winter D A, Mcfadyen B J, Dickey J P. Adaptability of the CNS in Human Walking[M]. North-Holland: Elsevier, 1991: 127-144.

组别	n	TUGT	FTSST
L组	12	12.53±0.62	11.92±0.51
H组	15	14.28±0.97	15.23±0.49
t值		5.421	17.113
P值		< 0.001	< 0.001

组别	n	跨越腿摆动时间	摆动腿摆动时间	跨越总时间
L组	12	0.28±0.04	0.27±0.03	0.60±0.06
H组	15	0.31±0.06	0.29±0.02	0.66±0.07
t值		2.073	1.869	2.215
P值		0.044	0.071	0.038

组别	n	跨越步长	跨越腿摆动净高度	摆动腿摆动净高度	最大质心高度
L组	12	0.36±0.04	0.10±0.02	0.11±0.03	0.58±0.02
H组	15	0.35±0.03	0.09±0.02	0.07±0.02	0.52±0.11
t值		-0.737	-0.914	-1.381	-2.014
P值		0.472	0.369	0.194	0.039

部位		L组(n = 12)	H组(n = 15)	t值	P值
跨越腿	髋关节	145.42±8.74	146.80±13.66	0.304	0.762
	膝关节	123.92±7.99	135.00±18.33	2.106	0.038
	踝关节	92.92±9.02	97.93±9.60	1.331	0.203
摆动腿	髋关节	169.75±4.85	172.33±5.80	1.242	0.227
	膝关节	113.42±10.01	130.00±24.77	2.364	0.033
	踝关节	121.42±13.78	117.27±16.37	-0.701	0.492
t₁值		-7.534	-6.352
P₁值		< 0.001	< 0.001
t₂值		2.721	0.628
P₂值		0.023	0.535
t₃值		-5.684	-3.623
P₃值		< 0.001	0.003

部位		L组(n = 12)	H组(n = 15)	t值	P值
跨越腿	髋关节	0.86±0.50	0.52±0.23	-2.119	0.041
	膝关节	1.02±0.46	0.84±0.40	-1.082	0.288
	踝关节	2.40±0.97	1.71±0.91	-1.924	0.072
	质心	0.78±0.29	0.64±0.27	-1.246	0.217
摆动腿	髋关节	1.25±0.55	1.08±0.50	-0.840	0.411
	膝关节	2.31±0.72	1.82±0.61	-1.908	0.073
	踝关节	2.03±0.66	1.65±0.68	-1.444	0.162
	质心	0.94±0.28	0.80±0.28	-1.291	0.209
t₁值		-4.408	-4.604
P₁值		< 0.001	< 0.001
t₂值		-4.542	-5.228
P₂值		< 0.001	< 0.001
t₃值		1.092	0.205
P₃值		0.287	0.839
t₄值		-3.161	-2.364
P₄值		0.009	0.032

社区不同跌倒风险老年人跨越障碍的步态运动学特征分析

Gait Characteristics in Old People with Various Risks of Falling as Obstacle Crossing in Community

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 36

相关文章 15

Metrics

本文评价

推荐阅读 0

部位		L组(n = 12)	H组(n = 15)	t值	P值
跨越腿	髋关节	27.87±14.33	23.27±13.46	-0.861	0.403
	膝关节	29.30±19.23	28.06±17.11	-0.177	0.858
	踝关节	22.19±16.61	27.89±21.83	0.752	0.455
	质心	12.11±9.61	20.07±12.48	1.821	0.079
摆动腿	髋关节	21.53±11.69	22.85±14.11	0.264	0.795
	膝关节	21.44±12.66	25.72±10.85	0.953	0.352
	踝关节	37.80±23.22	16.17±9.32	-3.038	0.012
	质心	16.94±8.28	17.68±8.71	0.221	0.826
t₁值		1.187	0.083
P₁值		0.248	0.934
t₂值		1.183	0.447
P₂值		0.249	0.658
t₃值		-1.894	1.912
P₃值		0.071	0.066
t₄值		-1.319	0.608
P₄值		0.201	0.548

[1]	王航宇, 葛可可, 范永红, 都丽露, 邹敏, 封磊. 基于ICD-11和ICF主动式音乐疗法改善认知障碍老年人认知功能的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 36-43.
[2]	葛可可, 范永红, 王航宇, 都丽露, 李长江, 邹敏. 失眠老年人正念干预健康效益的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 54-60.
[3]	赵盼超, 纪仲秋, 姜桂萍, 文蕊香. 不同任务干扰对儿童早期步态特征和任务成本的影响[J]. 《中国康复理论与实践》, 2023, 29(9): 1072-1082.
[4]	胡晓诗, 张琦, 岳青, 梁艳华, 李晓松, 冯啊美, 张燕庆. 矫形弹力绷带对痉挛性偏瘫脑性瘫痪患儿步态对称性和步行能力的效果[J]. 《中国康复理论与实践》, 2023, 29(9): 1083-1089.
[5]	杨雅楠, 穆丽萍, 邢凤梅, 薛新宏, 王晓光, 陶徉聿, 孙竹梅, 张小丽. 基于计划行为理论的干预对肌少症老年人肌肉衰减状况及平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 869-874.
[6]	张意彬, 吕杰, 喻洪流. 基于模糊逻辑算法的智能膝关节假肢步态相位识别[J]. 《中国康复理论与实践》, 2023, 29(8): 896-902.
[7]	蒋长好, 黄辰, 高晓妍, 戴元富, 赵国明. 神经反馈训练对老年人认知功能效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(8): 903-909.
[8]	王一吉, 周红俊, 何泽佳, 刘根林, 郑樱, 郝春霞, 卫波, 康海琼, 张缨, 逯晓蕾, 袁媛, 蒙倩茹. 不完全性脊髓损伤患者运动功能对称性与步态对称性的关系[J]. 《中国康复理论与实践》, 2023, 29(6): 639-645.
[9]	谭晓欢, 姜桂萍, 黄芯怡, 王丹丹, 张磊, 卜庆国, 吴雪萍. 社区高龄老年人下肢肌力与步速的关系：柔韧和动态平衡的链式中介作用[J]. 《中国康复理论与实践》, 2023, 29(6): 646-653.
[10]	朱晓敏, 刘惠林, 刘元旻, 闫志宇, 杜雪晶, 王亚囡, 张通. 脑卒中患者步行中自发性转身方向与平衡和跌倒风险间的关系[J]. 《中国康复理论与实践》, 2023, 29(5): 510-515.
[11]	袁媛, 杨剑. 社区老年人身体活动融合慢性病管理的健康效益：Scoping综述[J]. 《中国康复理论与实践》, 2023, 29(5): 541-550.
[12]	张意彬, 李剑峰, 喻洪流. 一种智能膝关节假肢及其步态对称性评价[J]. 《中国康复理论与实践》, 2023, 29(4): 402-407.
[13]	王芳, 杨涛, 何耀广, 曹子君, 刘国庆, 胡军, 张建国, 樊瑜波. 基于糖尿病患者步态周期足底压力的变刚度鞋垫设计[J]. 《中国康复理论与实践》, 2023, 29(4): 408-415.
[14]	罗启航, 吴羽皙, 张嘉璇, 黎婉颖, 欧海宁, 林强, 梁俊杰. 老年人平衡功能的脑网络变化：基于功能性近红外线光谱研究[J]. 《中国康复理论与实践》, 2023, 29(2): 238-242.
[15]	马红颖, 刘建军, 何学金, 王宇翔. 节律性听觉刺激对脑性瘫痪患者步态改善的系统综述[J]. 《中国康复理论与实践》, 2023, 29(12): 1386-1394.