在过去的5年中,有88%的双侧前庭功能障碍患者至少有一次跌倒。由于双侧前庭功能障碍(BVD)的明显交替是步态特征,例如较慢的步行速度,长时间的站立阶段,和更短的步长。出乎意料的是,由于BVD的患病率相对较低,注意力与其他前庭疾病不同。此外,如何在不同的斜坡上行走,日常活动的一部分,在不可靠的双侧前庭系统下改变步态特征?先前的研究使用基于振动的刺激(VS)作为扰动,以了解在双侧前庭系统受到扰动时行走过程中的姿势控制。因此,这项研究试图扩展知识,以了解在不同倾斜度行走时,在扰动的双侧前庭系统下,时空步态特征的变化。
19名健康的年轻人参加了这项研究。8个步行条件被随机分配给每个参与者:0%,3%,6%,和9%坡度的倾斜有/没有VS。优选的步行速度用于步态分析。因变量是站立时间,双重支持时间,步长,步进时间,步长,脚间隙,和各自的可变性。所有因变量由两个关键步态事件定义:脚跟撞击和脚趾离开。使用带有Bonferroni校正的Pre-Hoc配对比较来确定因变量的优先级。使用双向重复测量来研究VS的影响和倾斜对Pre-Hoc分析中选定的因变量的影响。事后比较也通过Bonferroni方法校正。
步长,步进时间,脚间隙,通过Pre-Hoc分析选择和足间隙变异性,因为校正的配对t检验在四个倾斜度中的至少一个上显示对这些步态参数的显著VS效应(p<0.05)。VS效应和倾斜效应之间的显着相互作用在步长中发现(p=0.005),步进时间(p=0.028),和足间隙变异性(p=0.003)。结果表明,当在0%上行走时,实施VS增加了步长和步进时间,3%,和9%的坡度。特别是,在9%的坡度上行走时,发现了脚间隙的变异性。
当前研究中的观察表明,VS增加了步长,步进时间,脚间隙,和脚间隙的可变性,而在斜坡上行走。这些结果表明,这些步态参数可能是BVD患者在不同倾斜度行走时的未来临床研究的有希望的目标。重要的是,双侧VS下时空步态表现的增加可能是在不同倾斜度行走时步态改善的指标。
Eighty-eight percent of the persons with bilateral vestibular dysfunction have reported at least one fall within the past 5 years. The apparent alternations due to the bilateral vestibular dysfunctions (BVD) are the gait characteristics, such as slower walking speed, prolonged stance phase, and shorter step length. Unexpectedly, due to the prevalence of this BVD being relatively low, attention is not obtained as same as in other vestibular disorders. Moreover, how does walking on different inclines, part of daily activities, alter the gait characteristics under the unreliable bilateral vestibular systems? Previous studies used vibration-based stimulations (VS) as a perturbation to understand the postural control during walking while the bilateral vestibular systems were perturbed. Therefore, this study attempted to extend the knowledge to understand the alternations in spatial-temporal gait characteristics under perturbed bilateral vestibular systems while walking on different inclines.
Nineteen healthy young adults participated in this study. Eight walking conditions were randomly assigned to each participant: 0%, 3%, 6%, and 9% grade of inclines with/without VS. The preferred walking speed was used for gait analysis. The dependent variables were stance time, double support time, step length, step time, step width, foot clearance, and respective variabilities. All dependent variables were defined by two critical gait events: heel-strike and toe-off. Pre-Hoc paired comparisons with Bonferroni corrections were used to prioritize the dependent variables. A two-way repeated measure was used to investigate the effect of VS and the effect of inclines on the selected dependent variables from Pre-Hoc analysis. Post-Hoc comparisons were also corrected by the Bonferroni method.
The step length, step time, foot clearance, and foot clearance variability were selected by the Pre-Hoc analysis because the corrected paired t-test demonstrated a significant VS effect (p < 0.05) on these gait parameters at least one of four inclines. The significant interaction between the effect of VS and the effect of inclines was found in step length (p = 0.005), step time (p = 0.028), and foot clearance variability (p = 0.003). The results revealed that implementing a VS increased step length and step time when walking on 0%, 3%, and 9% of grade inclines. In particular, the foot clearance variability was found when walking on 9% of grade inclines.
The observations in the current study suggested that VS increased the step length, step time, foot clearance, and foot clearance variability while walking on inclines. These results suggested that these gait parameters might be promising targets for future clinical investigations in patients with BVD while walking on different inclines. Importantly, the increases in spatial-temporal gait performance under bilateral VS might be an indicator of gait improvement while walking on different inclines.