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Interventions for coordination of walking following stroke: Systematic review

机译：中风后行走协调的干预措施：系统评价

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Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking post-stroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions.Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only.Results show that physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task-specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However, establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke. Future research requires the measurement of impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved.
机译：步态协调障碍可能是中风后跌倒和行动不便的一个因素。因此，以步态协调为目标的康复可能是改善中风后步行的有效方法。这篇综述旨在研究针对步态协调障碍的现有治疗方法，其衍生的理论基础以及此类干预措施的效果。很少找到高质量，低偏倚风险的RCTs专门针对和测量协调步态的恢复。因此，我们采取了务实的方法来描述和量化现有证据，并纳入了非随机研究设计，并通过将荟萃分析仅限于实验干预措施的测试前和测试后比较，限制了异质性对实验设计和对照比较器的影响。结果表明，理疗干预可以显着改善步态功能和协调能力。涉及重复性特定任务练习和/或听觉提示的干预似乎是恢复步态协调的最有前途的方法。步态协调性的总体改善与步行速度的增加相吻合的事实为以下假设提供了支持：定向步态协调性步态可能是改善中风后整体步行能力的一种方式。然而，建立改善运动控制的机制需要更好地了解中风后功能性任务中神经可塑性和协调缺陷的性质。未来的研究需要对损伤，活性和皮质激活进行测量，以建立实现功能获得的机制。

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