股四头肌痉挛对脑卒中患者跨越障碍的影响

doi:10.3969/j.issn.1006-9771.2021.07.003

Abstract

Abstract:

Objective To observe the effect of quadriceps femoris spasticity on the movement parameters in stroke patients during obstacle crossing.

Methods From October, 2017 to November, 2018, 20 stroke patients were divided into spasticity group (n = 11) and non-spasticity group (n = 9) based on the score of modified Ashworth Scale (MAS) of quadriceps femoris. A 10-camera 3D motion analysis system and two force plates were used to synchronously measure the movement parameters of the patients during obstacle crossing of 15 cm high, such as step length, step width, anterior-posterior velocity of the center of mass (COMAPV) and medio-lateral velocity of the center of mass, toe-obstacle distance of unaffected limb, toe-obstacle clearance of affected limb, heel-obstacle distance, double support phase, and the swing phases of affected and unaffected limb.

Results Compared with the non-spasticity group, the COMAPV decreased as both affected and unaffected limb above the obstacle in the spasticity group (F > 10.006, P < 0.01), as well as the toe-obstacle distance and step length before obstacle crossing (F > 13.456, P < 0.01); while, the double support phase and the step width after obstacle crossing increased (F > 4.533, P < 0.05).

Conclusion The quadriceps femoris spasticity may make the strategy of obstacle crossing more carefully for stroke patients, and less efficiently.

Key words: stroke, knee, spasticity, obstacle crossing, biomechanics

CLC Number:

R743.3

YU Xiao-ming,HUANG Shang-jun,QIAO Jun,LU Yan,HU Jun. Influences of Quadriceps Femoris Spasticity on Obstacle Crossing for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 755-759.

Figures/Tables 2

References 42

[1]	BALASUBRAMANIAN C K, CLARK D J, FOX E J. Walking adaptability after a stroke and its assessment in clinical settings[J]. Stroke Res Treat, 2014, 2014:591013.
[2]	HAN J T, LEE J H, FELL D W. Kinematic head and trunk strategies used by hemiplegic stroke patients crossing over obstacles of different heights[J]. J Phys Ther Sci, 2017, 29(1):109-111. doi: 10.1589/jpts.29.109
[3]	HUANG S J, YU X M, WANG K, et al. Short-step adjustment and proximal compensatory strategies adopted by stroke survivors with knee extensor spasticity for obstacle crossing[J]. Front Bioeng Biotechnol, 2020, 8:939. doi: 10.3389/fbioe.2020.00939
[4]	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 Z L, ZHANG Q L, LIU C Y. Gait characteristics in old people with various risks of falling as obstacle crossing in community[J]. Chin J Rehabil Theory Pract, 2020, 26(1):110-114.
[5]	LI S, LIU J, BHADANE M, et al. Activation deficit correlates with weakness in chronic stroke: evidence from evoked and voluntary EMG recordings[J]. Clin Neurophysiol, 2014, 125(12):2413-2417. doi: 10.1016/j.clinph.2014.03.019
[6]	GORST T, ROGERS A, MORRISON S C, et al. The prevalence, distribution, and functional importance of lower limb somatosensory impairments in chronic stroke survivors: a cross sectional observational study[J]. Disabil Rehabil, 2019, 41(20):2443-2450. doi: 10.1080/09638288.2018.1468932
[7]	TRUMBOWER R D, RAVICHANDRAN V J, KRUTKY M A, et al. Contributions of altered stretch reflex coordination to arm impairments following stroke[J]. J Neurophysiol, 2010, 104(6):3612-3624. doi: 10.1152/jn.00804.2009
[8]	SALEHI R, MOFATEH R, MEHRAVAR M, et al. Comparison of the lower limb inter-segmental coordination during walking between healthy controls and people with multiple sclerosis with and without fall history[J]. Mult Scler Relat Disord, 2020, 41:102053. doi: 10.1016/j.msard.2020.102053
[9]	CHEN N, XIAO X, HU H, et al. Identify the alteration of balance control and risk of falling in stroke survivors during obstacle crossing based on kinematic analysis[J]. Front Neurol, 2019, 10:813. doi: 10.3389/fneur.2019.00813
[10]	DEN OTTER A R, GEURTS A C, DE HAART M, et al. Step characteristics during obstacle avoidance in hemiplegic stroke[J]. Exp Brain Res, 2005, 161(2):180-192. doi: 10.1007/s00221-004-2057-0
[11]	SUN R, CUI C, SHEA J B. Aging effect on step adjustments and stability control in visually perturbed gait initiation[J]. Gait Posture, 2017, 58:268-273. doi: 10.1016/j.gaitpost.2017.08.013
[12]	MALIK R N, COTE R, LAM T. Sensorimotor integration of vision and proprioception for obstacle crossing in ambulatory individuals with spinal cord injury[J]. J Neurophysiol, 2017, 117(1):36-46. doi: 10.1152/jn.00169.2016
[13]	SAID C M, GOLDIE P A, CULHAM E, et al. Control of lead and trail limbs during obstacle crossing following stroke[J]. Phys Ther, 2005, 85(5):413-427. doi: 10.1093/ptj/85.5.413
[14]	SAID C M, GALEA M, LYTHGO N. Obstacle crossing performance does not differ between the first and subsequent attempts in people with stroke[J]. Gait Posture, 2009, 30(4):455-458. doi: 10.1016/j.gaitpost.2009.07.004
[15]	LU T W, YEN H C, CHEN H L, et al. Symmetrical kinematic changes in highly functioning older patients post-stroke during obstacle-crossing[J]. Gait Posture, 2010, 31(4):511-516. doi: 10.1016/j.gaitpost.2010.02.012
[16]	MACLELLAN M J, RICHARDS C L, FUNG J, et al. Comparison of kinetic strategies for avoidance of an obstacle with either the paretic or non-paretic as leading limb in persons post stroke[J]. Gait Posture, 2015, 42(3):329-334. doi: 10.1016/j.gaitpost.2015.06.191
[17]	陈娜, 毛玉瑢, 黄东锋, 等. 脑卒中患者跨越不同高度障碍物的运动学分析[J]. 中国康复医学杂志, 2015, 30(4):334-338.
	CHEN N, MAO Y R, HUANG D F, et al. Kinematic analysis of crossing obstacle with different height following stroke[J]. Chin J Rehabil Med, 2015, 30(4):334-338.
[18]	GUPTA A D, CHU W H, HOWELL S, et al. A systematic review: efficacy of Botulinum toxin in walking and quality of life in post-stroke lower limb spasticity[J]. Syst Rev, 2018, 7(1):1. doi: 10.1186/s13643-017-0670-9
[19]	CABANAS-VALDES R, CALVO-SANZ J, URRUTIA G, et al. The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis[J]. Top Stroke Rehabil, 2020, 27(2):137-157. doi: 10.1080/10749357.2019.1654242
[20]	YANG J M, KIM S Y. Correlation of knee proprioception with muscle strength and spasticity in stroke patients[J]. J Phys Ther Sci, 2015, 27(9):2705-2708. doi: 10.1589/jpts.27.2705
[21]	RAHIMZADEH KHIABANI R, MOCHIZUKI G, ISMAIL F, et al. Impact of spasticity on balance control during quiet standing in persons after stroke[J]. Stroke Res Treat, 2017, 2017:6153714.
[22]	SINGER J C, MANSFIELD A, DANELLS C J, et al. The effect of post-stroke lower-limb spasticity on the control of standing balance: inter-limb spatial and temporal synchronisation of centres of pressure[J]. Clin Biomech (Bristol, Avon), 2013, 28(8):921-926. doi: 10.1016/j.clinbiomech.2013.07.010
[23]	SINGER J C, MOCHIZUKI G. Post-stroke lower limb spasticity alters the interlimb temporal synchronization of centre of pressure displacements across multiple timescales[J]. IEEE Trans Neural Syst Rehabil Eng, 2015, 23(5):786-795. doi: 10.1109/TNSRE.7333
[24]	吴逊. 全国第四届脑血管病学术会议纪要[J]. 卒中与神经疾病, 1997, 4(2):51-55.
	WU X. Stroke Nerv Dis, 1997, 4(2):51-55.
[25]	CASTILLO J. Deteriorating stroke: diagnostic criteria, predictors, mechanisms and treatment[J]. Cerebrovasc Dis, 1999, 9(3):1-8.
[26]	MURAYAMA N, OTA K, MATSUNAGA Y, et al. Evaluating depression in cognitively healthy elderly people by using Mini-Mental State Examination[J]. Psychogeriatrics, 2020, 20(1):96-103. doi: 10.1111/psyg.v20.1
[27]	ZURAWSKI E, BEHM K, DUNLAP C, et al. Interrater reliability of the modified Ashworth Scale with standardized movement speeds: a pilot study[J]. Physiother Can, 2019, 71(4):348-354. doi: 10.3138/ptc-2018-0086
[28]	ANSARI N N, NAGHDI S, YOUNESIAN P, et al. Inter- and intrarater reliability of the modified Ashworth Scale in patients with knee extensor poststroke spasticity[J]. Physiother Theory Pract, 2008, 24(3):205-213. doi: 10.1080/09593980701523802
[29]	DOWNS S. The Berg Balance Scale[J]. J Physiother, 2015, 61(1):46. doi: 10.1016/j.jphys.2014.10.002
[30]	HERNANDEZ E D, FORERO S M, GALEANO C P, et al. Intra- and interrater reliability of Fugl-Meyer Assessment of lower extremity early after stroke[J]. Braz J Phys Ther, 2020, 12:10.
[31]	TEIXEIRA-SALMELA L F, NADEAU S, MILOT M H, et al. Effects of cadence on energy generation and absorption at lower extremity joints during gait[J]. Clin Biomech (Bristol, Avon), 2008, 23(6):769-778. doi: 10.1016/j.clinbiomech.2008.02.007
[32]	RAFFEGEAU T E, KELLAHER G K, TERZA M J, et al. Older women take shorter steps during backwards walking and obstacle crossing[J]. Exp Gerontol, 2019, 122:60-66. doi: 10.1016/j.exger.2019.04.011
[33]	SAID C M, GALEA M P, LYTHGO N. People with stroke who fail an obstacle crossing task have a higher incidence of falls and utilize different gait patterns compared with people who pass the task[J]. Phys Ther, 2013, 93(3):334-344. doi: 10.2522/ptj.20120200
[34]	VISTAMEHR A, BALASUBRAMANIAN C K, CLARK D J, et al. Dynamic balance during walking adaptability tasks in individuals post-stroke[J]. J Biomech, 2018, 74:106-115. doi: 10.1016/j.jbiomech.2018.04.029
[35]	SAID C M, GOLDIE P A, PATLA A E, et al. Effect of stroke on step characteristics of obstacle crossing[J]. Arch Phys Med Rehabil, 2001, 82(12):1712-1719. doi: 10.1053/apmr.2001.26247
[36]	SAID C M, GOLDIE P A, PATLA A E, et al. Balance during obstacle crossing following stroke[J]. Gait Posture, 2008, 27(1):23-30. doi: 10.1016/j.gaitpost.2006.12.009
[37]	MA C, CHEN N, MAO Y, et al. Alterations of muscle activation pattern in stroke survivors during obstacle crossing[J]. Front Neurol, 2017, 8:70.
[38]	KHANMOHAMMADI R, TALEBIAN S, HADIAN M R, et al. Preparatory postural adjustments during gait initiation in healthy younger and older adults: neurophysiological and biomechanical aspects[J]. Brain Res, 2015, 1629:240-249. doi: 10.1016/j.brainres.2015.09.039
[39]	TISSERAND R, ROBERT T, CHABAUD P, et al. Elderly fallers enhance dynamic stability through anticipatory postural adjustments during a choice stepping reaction time[J]. Front Human Neurosci, 2016, 10:362-368. doi: 10.3389/fpsyg.2019.00362
[40]	JACOBS J V, LYMAN C A, HITT J R, et al. Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments[J]. Human Mov Sci, 2017, 54:210-219. doi: 10.1016/j.humov.2017.05.007
[41]	WU K W, LI J D, HUANG H P, et al. Bilateral asymmetry in kinematic strategies for obstacle-crossing in adolescents with severe idiopathic thoracic scoliosis[J]. Gait Posture, 2019, 71:211-218. doi: 10.1016/j.gaitpost.2019.05.007
[42]	RIJKEN N H M, VAN ENGELEN B G M, GEURTS A C H, et al. Dynamic stability during level walking and obstacle crossing in persons with facioscapulohumeral muscular dystrophy[J]. Gait Posture, 2015, 42(3):295-300. doi: 10.1016/j.gaitpost.2015.06.005

特征	无痉挛组(n = 9)	痉挛组(n = 11)	χ²/F值	P值
性别(男/女, n)	6/3	9/2	0.617	0.396
年龄(岁)	61.33±7.53	60.02±8.79	0.129	0.724
身高(cm)	168.78±3.89	171.09±6.89	0.799	0.383
体质量(kg)	67.39±3.18	73.81±8.76	4.316	0.052
卒中类型(梗死/出血, n)	5/4	9/2	0.336	0.217
病程(d)	280.67±187.82	320.01±195.29	0.208	0.654
MAS	0.00±0.00	1.45±0.47	84.637	< 0.001
MMSE	28.11±2.52	27.55±2.02	0.311	0.584
Fugl-Meyer评定量表下肢部分	28.44±2.55	25.82±6.78	1.201	0.288
Berg平衡量表	48.89±3.79	45.73±3.72	3.519	0.077

参数	无痉挛组(n= 9)	痉挛组(n= 11)	F值	P值
COMAPV1 (m/s)	0.47±0.17	0.25±0.09	12.542	0.002
COMMLV1 (m/s)	0.02±0.01	0.02±0.02	0.082	0.778
COMAPV2 (m/s)	0.53±0.15	0.35±0.11	10.006	0.005
COMMLV2 (m/s)	0.04±0.03	0.04±0.04	0.098	0.758
TOD (m)	0.22±0.07	0.12±0.04	13.456	0.002
TOC (m)	0.13±0.04	0.11±0.08	0.211	0.651
HOD (m)	0.10±0.06	0.07±0.05	1.905	0.184
障碍前步长(m)	0.48±0.03	0.17±0.06	216.380	< 0.001
障碍后步长(m)	0.34±0.19	0.21±0.17	2.787	0.112
障碍前步宽(m)	0.08±0.06	0.10±0.04	0.608	0.446
障碍后步宽(m)	0.11±0.04	0.15±0.04	4.533	0.047
障碍前双支撑期(%)	9.23±2.33	13.34±14.62	5.381	0.032
患侧摆动期(%)	46.79±4.37	44.67±4.86	1.031	0.323
障碍中双支撑期(%)	8.18±2.50	10.60±4.35	2.180	0.157
健侧摆动期(%)	35.80±7.65	31.40±7.46	1.681	0.211

Influences of Quadriceps Femoris Spasticity on Obstacle Crossing for Stroke Patients

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 42

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHU Lili, ZHAO Jiaxin, CHENG Xue, WANG Huijuan, CHEN Xiaoxia. Experiences and needs of stroke patients during rehabilitation: a qualitative meta-synthesis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 286-293.
[2]	LIU Ping, ZHOU Nan, XUE Xiaojie, SHAO Weibo. Application of rehabilitation therapy techniques for post-stroke dysphagia: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 294-303.
[3]	YANG Ling, WANG Qinglei, WANG Jie, XU Wenjie, WANG Tong, GUO Chuan, QIAN Xue. Activation patterns and mechanism in the prefrontal cortex of post-stroke anxiety patients: a study using functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 329-336.
[4]	LIANG Guanjun, XU Huanlan, ZHANG Hewei, ZHANG Dali, GU Qin, LI Mingdi. Changes in balance and lower limb biomechanics of spastic hemiplegia under different visual deprivation and task conditions [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 345-355.
[5]	WANG Zhiwei, MENG Lijun, WU Yu, LIU Jian, DA Zhaojin, YAN Zeping, WU Shicai. Network analysis of pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty from an ethical equity perspective [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 364-372.
[6]	YUE Yuan, ZHANG Tong, LIU Yuanmin, WANG Ya'nan. Effect of lower extremity exoskeleton robots on balance and walking function of patients with post-stroke cerebellar ataxia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 23-29.
[7]	WU Cheng, ZHANG Yunfeng, WANG Weining, YU Kewei, ZHANG Yanzheng, SHEN Jiarong, WU Yi. Effect of elbow-wrist functional orthosis on plantar pressure and balance function in stroke patients with hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 30-39.
[8]	ZHANG Junfeng, CHEN Hao, DU Yuzheng, LI Chen, YU Tao, YANG Yuanqing. Non-pharmacological management for post-stroke spasticity from 2004 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 45-58.
[9]	GAO Kaixiang, LU Haitao. Research in neurorehabilitation from 2015 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 59-68.
[10]	WEI Jingyi, WANG Xiaojing, WANG Ran, WEI Chen, MA Sai, LIU Xihua. Effect of acupuncture synchronized speech training on post-stroke motor aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1000-1008.
[11]	WANG Xiaojing, WEI Jingyi, WEI Chen, WANG Ran, MA Sai, LIU Xihua. Effect of synchronous acupuncture and articulation training on spastic dysarthria after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1009-1016.
[12]	ZHOU Xinyue, YE Ruixue, MA Yaqi, XU Ying, CAO Longyao, WANG Yulong. Researches on central post-stroke pain: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1038-1049.
[13]	GAO Yunhan, HOU Shanshan, WANG Xinyu, ZHU Chongtian. Effect of brain-computer interface on upper limb motor dysfunction in stroke patients based on functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1066-1073.
[14]	GAO Fei, LIU Lixu, HU Xueyan, WU Xiaoli, YANG Lingyu, YANG Yuqi, YE Changqing, DU Xiaoxia. Effect of unilateral or bilateral transcranial direct current stimulation on post-stroke dysphagia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 993-999.
[15]	ZHANG Ziang, CHEN Jing, SHEN Mengru, GENG Zongxiao, HAN Xue, ZHAO Xu, XU Lei. Comparison of effect of different types of exercise on gait and balance for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 896-905.