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- 您请求的操作仅限于组中的用户:中风后的步态 ===异常的步态模式是中风后常见的损害,这是由于运动[[大脑皮层|皮质]]中的神经通路、它们与[[脑干]]及其[[脊髓解剖|下行通路]]和脊柱内运动网络中的神经通路被破坏所致。这种损伤导致观察到的肌肉无力,肌肉张力的变化,以及异常的协同运动模式,通常见于中风患者。[参考]李松,Francisco GE,周鹏[https://www.frontiersin.org/articles/10.3389/fphys.2018.01021/full脑卒中后偏瘫步态:新的视角和见解。生理学的前沿。2018; 9:1021。可从:https://www.frontiersin.org/articles/10.3389/fphys.2018.01021/full(最后访问日期为2019年11月29日)。继发性损伤源于[[心血管系统]]和肌肉骨骼系统源于废弃和缺乏运动,可增加行走困难。中风后产生的步态模式通常是运动偏差和新的代偿运动模式的结合,这是该人受伤所特有的。Balaban, Birol等:卒中患者的步态障碍:PM&R,卷6,第7期,635 - 642。与所有康复项目一样,中风后的步态训练是高度个性化的。下面的视频展示了一个渐进强化的个体化步态训练的例子。{{#ev:youtube|https://www.youtube.com/watch?v=g__BYaS9viw|width}}海斯医院物理治疗恢复中风后行走可从https://www.youtube.com/watch?v=g__BYaS9viw(最后访问日期:2019年11月29日) ====中风后步态的典型运动学偏差==== {| class="wikitable" |+Janet H carr EdD FACP, Roberta B Shepherd EdD FACP; Stroke Rehabilitation- Guidelil1es for Exercise and Training to Optimize Motor Skill ; First edition; 2003 ! !'''Gait Deviation''' !'''Clinical Observation''' |- | rowspan="2" |'''Initial Stance''' |Limited ankle dorsiflexion | * decreased activation of anterior tibial muscles * contracture and/or stiffness of calf muscles with premature activation. |- |Lack of knee flexion (knee hyperextension) | * contracture of soleus * limited control of quadriceps 0-15° |- | rowspan="4" |'''Midstance''' |Lack of Knee Extension (knee remains flexed 10-150 with excessive ankle dorsiflexion) | * decreased activation of calf muscles to control movement of shank forward at the ankle (ankle dorsiflexion) * limited synergic activation of lower limb extensor muscles |- |Knee Hyperextension (This interferes with preparation for push-off ) |contracture of soleus (an adaptation to fear of limb collapse due to weakness of muscles controlling the knee) |- |Limited hip extension and ankle dorsiflexion with failure to progress body mass forward over the foot |contracture of soleus |- |Excessive Lateral Pelvic Shift |decreased ability to activate stance hip abductors and control hip and knee extensors |- |'''Late Stance (Pre-swing)''' |Lack of Knee Flexion and Ankle Plantar-flexion (prerequisites for push-off and preparation for swing) |weakness of calf muscles |- |'''Early and Mid-swing''' |Limited Knee Flexion normally 35-40° increasing to 60° for swing and toe clearance | * increased stiffness in or unopposed activity of two-joint rectus femoris * decreased activation of hamstrings |- |'''Late-swing''' |Limited Knee Extension and Ankle Dorsiflexion jeopardising heel contact and weight-acceptance | * contracted or stiff calf muscles * decreased dorsiflexor activity |} {{#ev:youtube|ihz74Zv6D84}} Hemiplegic Gait – Case Study 13 Available from:
https://www.youtube.com/watch?v=ihz74Zv6D84last accessed 23.10.2021) As can be seen in the above videos, the persons with stroke demonstrated the following spatiotemporal adaptations: decreased walking speed, short and/or uneven step and stride lengths, increased stride width, increased double support phase, and dependence on assistive device through the hands.